Provider Demographics
NPI:1558558643
Name:CENTRAL PRIVATE MEDICAL PRACTICE OF BROOKLYN
Entity Type:Organization
Organization Name:CENTRAL PRIVATE MEDICAL PRACTICE OF BROOKLYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-258-5602
Mailing Address - Street 1:1476 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3102
Mailing Address - Country:US
Mailing Address - Phone:718-258-5602
Mailing Address - Fax:718-258-5605
Practice Address - Street 1:1476 E 48TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3102
Practice Address - Country:US
Practice Address - Phone:718-258-5602
Practice Address - Fax:718-258-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty