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NPI Code Detail

MEDICARE: INTERBORO SURGICAL ASSOCIATES, P.C.

MEDICARE: INTERBORO SURGICAL ASSOCIATES, 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
1208600000XSurgery Physician222936NY

General Provider Information

NPI Number : 1679670210
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERBORO SURGICAL ASSOCIATES, P.C.
Provider Business Mailing Address
First Line : 8318 4TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11209-4413
Country : US
Telephone Number : 718-748-0500
Fax Number : 718-748-5539
Provider Business Practice Location Address
First Line : 8318 4TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11209-4413
Country : US
Telephone Number : 718-748-0500
Fax Number : 718-748-5539
Authorized Official
Title or Position : DIRECTOR
Name : DR. GREGORY R. BREVETTI
Credential : M.D.
Telephone Number : 718-748-0500
Provider Enumeration Date : 09/17/2006
Last Update Date : 08/22/2020

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Directions to “INTERBORO SURGICAL ASSOCIATES, P.C. ” Practice Location

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