MEDICARE: CENTRAL BROOKLYN MEDICAL GP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1023139151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL BROOKLYN MEDICAL GP LLC

Provider Business Mailing Address
First Line	:	1423 GLOVER STREET
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-4919
Country	:	US
Telephone Number	:	718-597-8383
Fax Number	:	718-892-0234

Provider Business Practice Location Address
First Line	:	1423 GLOVER STREET
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-4919
Country	:	US
Telephone Number	:	718-597-8383
Fax Number	:	718-892-0234

Authorized Official
Title or Position	:	MANAGER
Name	:	BEN UMEZE
Credential	:	MD
Telephone Number	:	718-597-8883

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/22/2020

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