MEDICARE: BROOKLYN HEIGHTS FAMILY PRACTICE, 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	207Q00000X	Family Medicine Physician	173438	NY

General Provider Information

NPI Number	:	1477507499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN HEIGHTS FAMILY PRACTICE, PC

Provider Business Mailing Address
First Line	:	185 MONTAGUE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3608
Country	:	US
Telephone Number	:	718-624-6185
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 MONTAGUE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3608
Country	:	US
Telephone Number	:	718-624-6185
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES BERK
Credential	:	MD
Telephone Number	:	718-624-6185

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	02/04/2008

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