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NPI Code Detail

MEDICARE: BROOKLYN TOTAL MEDICAL CARE P.C.

MEDICARE: BROOKLYN TOTAL MEDICAL CARE P.C.
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
1261QH0100XHealth Service Clinic/Center166454NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11659376119OTHERNYNPI FOR JAY WEISSBLUTH

General Provider Information

NPI Number : 1033351283
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROOKLYN TOTAL MEDICAL CARE P.C.
Provider Business Mailing Address
First Line : 3019 AVENUE U
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-5111
Country : US
Telephone Number : 718-934-1800
Fax Number : 718-891-5208
Provider Business Practice Location Address
First Line : 3019 AVENUE U
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-5111
Country : US
Telephone Number : 718-934-1800
Fax Number : 718-891-5208
Authorized Official
Title or Position : OWNER
Name : DR. JAY ELLIOT WEISSBLUTH
Credential : MD
Telephone Number : 718-934-1800
Provider Enumeration Date : 04/02/2009
Last Update Date : 04/02/2009

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