Provider Demographics
NPI:1881794782
Name:BROOKLYN MEDICAL P.L.L.C
Entity type:Organization
Organization Name:BROOKLYN MEDICAL P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUTHUSWAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAMURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-499-9020
Mailing Address - Street 1:263 7TH AVE
Mailing Address - Street 2:SUITE 4G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3689
Mailing Address - Country:US
Mailing Address - Phone:718-499-9020
Mailing Address - Fax:718-499-9021
Practice Address - Street 1:263 7TH AVE
Practice Address - Street 2:SUITE 4G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3689
Practice Address - Country:US
Practice Address - Phone:718-499-9020
Practice Address - Fax:718-499-9021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02167233Medicaid
NY02167233Medicaid