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NPI Code Detail

MEDICARE: EAST BROOKLYN MEDICAL GROUP PC

MEDICARE: EAST BROOKLYN MEDICAL GROUP 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
1207R00000XInternal Medicine Physician188900NY

General Provider Information

NPI Number : 1689871469
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST BROOKLYN MEDICAL GROUP PC
Provider Business Mailing Address
First Line : 1718 PITKIN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11212-6604
Country : US
Telephone Number : 718-485-9869
Fax Number : 718-485-4213
Provider Business Practice Location Address
First Line : 1718 PITKIN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11212-6604
Country : US
Telephone Number : 718-485-9869
Fax Number : 718-485-4213
Authorized Official
Title or Position : MEDICAL DOCTOR
Name : DR. JACQUES CLAUDEL ANTOINE
Credential : MD
Telephone Number : 718-485-9869
Provider Enumeration Date : 06/27/2007
Last Update Date : 08/20/2007

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Directions to “EAST BROOKLYN MEDICAL GROUP PC ” Practice Location

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