Provider Demographics
NPI:1770844797
Name:KINGSBROOK MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:KINGSBROOK MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BATHEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-604-5578
Mailing Address - Street 1:6880 W SNOWVILLE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3254
Mailing Address - Country:US
Mailing Address - Phone:800-261-0048
Mailing Address - Fax:
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1891
Practice Address - Country:US
Practice Address - Phone:718-604-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGSBROOK MEDICAL ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-06
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty