Provider Demographics
NPI:1558707299
Name:AJS BROOKLYN MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:AJS BROOKLYN MEDICAL PRACTICE PC
Other - Org Name:AJS BROOKLYN MEDICAL PRACTICE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HONIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-436-5025
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:833-241-7615
Practice Address - Street 1:475 ATLANTIC AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1812
Practice Address - Country:US
Practice Address - Phone:718-369-4850
Practice Address - Fax:718-369-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center