Provider Demographics
NPI:1891733804
Name:EXPRESS MEDICAL PC
Entity Type:Organization
Organization Name:EXPRESS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISSAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BELOGOLOVKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-612-2247
Mailing Address - Street 1:3250 CONEY ISLAND AVE
Mailing Address - Street 2:#A5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-648-5858
Mailing Address - Fax:718-375-2735
Practice Address - Street 1:3059 BRIGHTON 7TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6414
Practice Address - Country:US
Practice Address - Phone:718-259-2700
Practice Address - Fax:718-259-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00951524Medicaid
D92242Medicare UPIN
NY00951524Medicaid