Provider Demographics
NPI:1760138648
Name:BROOKLYN MEDICAL OFFICE PLLC
Entity Type:Organization
Organization Name:BROOKLYN MEDICAL OFFICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHRORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BLIMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-662-2404
Mailing Address - Street 1:1681 44TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1049
Mailing Address - Country:US
Mailing Address - Phone:845-662-2404
Mailing Address - Fax:
Practice Address - Street 1:1681 44TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1049
Practice Address - Country:US
Practice Address - Phone:845-662-2404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty