MEDICARE: VAN CORTLAND MEDICAL, 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	206057	NY

General Provider Information

NPI Number	:	1669598850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAN CORTLAND MEDICAL, PC

Provider Business Mailing Address
First Line	:	2615 E 16TH ST
Second Line	:	1 FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 E 16TH ST
Second Line	:	1 FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3805
Country	:	US
Telephone Number	:	718-496-1888
Fax Number	:

Authorized Official
Title or Position	:	DO
Name	:	ALEXANDER FALKOVSKY
Credential	:
Telephone Number	:	718-496-1888

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	04/20/2008

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