MEDICARE: CENTRAL PRIVATE MEDICAL PRACTICE OF BROOKLYN

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1558558643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL PRIVATE MEDICAL PRACTICE OF BROOKLYN

Provider Business Mailing Address
First Line	:	1476 E 48TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3102
Country	:	US
Telephone Number	:	718-258-5602
Fax Number	:	718-258-5605

Provider Business Practice Location Address
First Line	:	1476 E 48TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3102
Country	:	US
Telephone Number	:	718-258-5602
Fax Number	:	718-258-5605

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARSHA A WESLEY
Credential	:	M.D.
Telephone Number	:	718-258-5602

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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