MEDICARE: DOWNSTATE MEDICAL CARE, 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	207RC0000X	Cardiovascular Disease Physician	1176961	NY

General Provider Information

NPI Number	:	1578747911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOWNSTATE MEDICAL CARE, P.C.

Provider Business Mailing Address
First Line	:	2678 GERRITSEN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5947
Country	:	US
Telephone Number	:	718-333-0275
Fax Number	:

Provider Business Practice Location Address
First Line	:	2678 GERRITSEN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5947
Country	:	US
Telephone Number	:	718-333-0275
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	PARVIZ H MOTAVALLI
Credential	:	M.D.
Telephone Number	:	718-333-0275

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	12/20/2007

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