Provider Demographics
NPI:1598309569
Name:BROOKLYN DOC MEDICAL P.C.
Entity Type:Organization
Organization Name:BROOKLYN DOC MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:ANANTHAKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:THILLAINATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-582-1948
Mailing Address - Street 1:10420 QUEENS BLVD STE 1DE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3629
Mailing Address - Country:US
Mailing Address - Phone:718-897-0900
Mailing Address - Fax:
Practice Address - Street 1:10420 QUEENS BLVD STE 1DE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3629
Practice Address - Country:US
Practice Address - Phone:718-806-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-03
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY291751Medicaid