Provider Demographics
NPI:1891798104
Name:BROOKLYN COMMUNITY MEDICAL PC
Entity Type:Organization
Organization Name:BROOKLYN COMMUNITY MEDICAL PC
Other - Org Name:BROOKLYN COMMUNITY OFFICE BASED SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:ABARHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-951-8800
Mailing Address - Street 1:2555 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4730
Mailing Address - Country:US
Mailing Address - Phone:718-951-8800
Mailing Address - Fax:718-951-0846
Practice Address - Street 1:2555 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4730
Practice Address - Country:US
Practice Address - Phone:718-951-8800
Practice Address - Fax:718-951-0846
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKLYN COMMUNITY MEDICAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-31
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ49681Medicare ID - Type Unspecified
NYQT7131Medicare ID - Type Unspecified
NYPG7801Medicare ID - Type Unspecified
NYQ3WNM1Medicare PIN
NY0099J1Medicare ID - Type Unspecified
NYQS6761Medicare ID - Type Unspecified