MEDICARE: BROOKLYN PSYCHIATRY PLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1073122164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	515 E 7TH ST APT 3F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4827
Country	:	US
Telephone Number	:	347-988-4824
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 PLAZA ST E STE P108
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-5047
Country	:	US
Telephone Number	:	347-988-4824
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AKINOLA ADEBISI
Credential	:	MD
Telephone Number	:	347-988-4824

Provider Enumeration Date	:	07/24/2020
Last Update Date	:	05/06/2021

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