Provider Demographics
NPI:1851685846
Name:BROOKLYN MEDICAL ASSOCIATE, LFPC
Entity Type:Organization
Organization Name:BROOKLYN MEDICAL ASSOCIATE, LFPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-336-4499
Mailing Address - Street 1:280 QUENTIN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1628
Mailing Address - Country:US
Mailing Address - Phone:718-336-4499
Mailing Address - Fax:
Practice Address - Street 1:280 QUENTIN RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1628
Practice Address - Country:US
Practice Address - Phone:718-336-4499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW33311Medicare PIN
NYW33313Medicare PIN
NYW33312Medicare PIN