Provider Demographics
NPI:1548430325
Name:BROOKLYN MEDICAL HEALTH & WELLNESS, P.C.
Entity Type:Organization
Organization Name:BROOKLYN MEDICAL HEALTH & WELLNESS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:BAUMGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-686-7564
Mailing Address - Street 1:PO BOX 670618
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-0618
Mailing Address - Country:US
Mailing Address - Phone:917-686-7564
Mailing Address - Fax:718-261-7606
Practice Address - Street 1:3043 OCEAN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3497
Practice Address - Country:US
Practice Address - Phone:718-332-7772
Practice Address - Fax:718-332-5329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty