Healthcare Provider Details

I. General information

NPI: 1366645871
Provider Name (Legal Business Name): AVENUE P MEDICAL ARTS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENUE P MEDICAL CENTER 209 AVENUE P
BROOKLYN NY
11204
US

IV. Provider business mailing address

209 AVENUE P
BROOKLYN NY
11204-4903
US

V. Phone/Fax

Practice location:
  • Phone: 718-259-6666
  • Fax: 718-259-7000
Mailing address:
  • Phone: 718-259-6666
  • Fax: 718-259-7000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. SIMON IRMAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 718-259-6666