MEDICARE: NEPHROLOGY ASSOCIATES OF BROOKLYN, 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	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1578775607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEPHROLOGY ASSOCIATES OF BROOKLYN, PC

Provider Business Mailing Address
First Line	:	219 BAY 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4905
Country	:	US
Telephone Number	:	718-372-2122
Fax Number	:	718-714-6990

Provider Business Practice Location Address
First Line	:	219 BAY 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4905
Country	:	US
Telephone Number	:	718-372-2122
Fax Number	:	718-714-6990

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN B PANNONE
Credential	:	M.D.
Telephone Number	:	718-372-2122

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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