MEDICARE: MEDICAL OFFICE

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	261Q00000X	Clinic/Center	195497	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174673446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL OFFICE

Provider Business Mailing Address
First Line	:	1821 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5005
Country	:	US
Telephone Number	:	718-531-2540
Fax Number	:	718-531-2540

Provider Business Practice Location Address
First Line	:	1821 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5005
Country	:	US
Telephone Number	:	718-531-2540
Fax Number	:	718-531-2540

Authorized Official
Title or Position	:	PRESIDENT ATTENTING
Name	:	MERITA PIERRE LOUIS
Credential	:	M.D.
Telephone Number	:	718-531-2540

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	08/22/2020

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Directions to “MEDICAL OFFICE ” Practice Location

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