MEDICARE: SHEEPSHEAD BAY MEDICAL ASSOCIATES, PC

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	207R00000X	Internal Medicine Physician

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	:	1184750564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEEPSHEAD BAY MEDICAL ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	3632 NOSTRAND AVE STE 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5308
Country	:	US
Telephone Number	:	718-615-0162
Fax Number	:	718-934-1324

Provider Business Practice Location Address
First Line	:	2912 AVENUE X
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1906
Country	:	US
Telephone Number	:	718-615-0162
Fax Number	:	718-934-1324

Authorized Official
Title or Position	:	MANAGER
Name	:	CAROL MANNING
Credential	:
Telephone Number	:	718-615-0162

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	03/27/2018

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