MEDICARE: GENERAL MEDICAL SERVICES OF KINGS HIGHWAY 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1518228386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERAL MEDICAL SERVICES OF KINGS HIGHWAY PC

Provider Business Mailing Address
First Line	:	5379 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-6703
Country	:	US
Telephone Number	:	718-480-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	5379 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-6703
Country	:	US
Telephone Number	:	718-480-5555
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TODD MILLER
Credential	:
Telephone Number	:	718-480-5555

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	06/07/2012

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