Provider Demographics
NPI:1639553969
Name:BRMI @ 5TH AVENUE
Entity Type:Organization
Organization Name:BRMI @ 5TH AVENUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHROKH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-238-7000
Mailing Address - Street 1:7601 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3207
Mailing Address - Country:US
Mailing Address - Phone:718-880-3066
Mailing Address - Fax:718-880-3067
Practice Address - Street 1:9020 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5908
Practice Address - Country:US
Practice Address - Phone:718-880-3066
Practice Address - Fax:718-880-3067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02390045Medicaid