Provider Demographics
NPI:1770816746
Name:BROKHIN MEDICAL, PC
Entity Type:Organization
Organization Name:BROKHIN MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDOCRINOLOGY PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MATVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROKHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-500-2160
Mailing Address - Street 1:170 MAJOR AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3735
Mailing Address - Country:US
Mailing Address - Phone:646-500-2160
Mailing Address - Fax:718-720-7492
Practice Address - Street 1:3131 KINGS HWY STE B10
Practice Address - Street 2:MEDICAL OFFICE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2643
Practice Address - Country:US
Practice Address - Phone:347-462-9292
Practice Address - Fax:646-393-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232962207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty