Provider Demographics
NPI:1770707622
Name:5000 AVENUE K MEDICAL ASSOCS PC
Entity type:Organization
Organization Name:5000 AVENUE K MEDICAL ASSOCS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-629-5590
Mailing Address - Street 1:1987 UTICA AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3225
Mailing Address - Country:US
Mailing Address - Phone:718-629-5590
Mailing Address - Fax:718-629-2833
Practice Address - Street 1:5000 AVENUE K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3225
Practice Address - Country:US
Practice Address - Phone:718-968-1515
Practice Address - Fax:718-209-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01412986Medicaid
NY01178192Medicaid