MEDICARE: EXCLUSE CARE MEDICAL 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
1	207R00000X	Internal Medicine Physician	227160	NY

General Provider Information

NPI Number	:	1396796694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCLUSE CARE MEDICAL P.C.

Provider Business Mailing Address
First Line	:	PO BOX 351154
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8954
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 FOSTER AVE
Second Line	:	STE B
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2119
Country	:	US
Telephone Number	:	718-338-0014
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ZARINA MANDELBLAT
Credential	:
Telephone Number	:	718-805-4255

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	04/10/2008

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