Provider Demographics
NPI:1609873116
Name:AMBULATORY SURGERY CENTER OF BROOKLYN, LLC
Entity Type:Organization
Organization Name:AMBULATORY SURGERY CENTER OF BROOKLYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:MONCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-369-2140
Mailing Address - Street 1:313 43RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-3609
Mailing Address - Country:US
Mailing Address - Phone:718-369-1900
Mailing Address - Fax:718-965-4157
Practice Address - Street 1:313 43RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-3609
Practice Address - Country:US
Practice Address - Phone:718-369-1900
Practice Address - Fax:718-965-4157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001244R261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00357575Medicaid
NYZ95141Medicare UPIN
NYZ95141Medicare ID - Type Unspecified