Healthcare Provider Details

I. General information

NPI: 1043375355
Provider Name (Legal Business Name): GRAND FAMILY IMMEDIATE MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 GRAND ST
BROOKLYN NY
11211-4937
US

IV. Provider business mailing address

678 GRAND ST
BROOKLYN NY
11211-4937
US

V. Phone/Fax

Practice location:
  • Phone: 718-218-8357
  • Fax:
Mailing address:
  • Phone: 718-218-8357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number1825141
License Number StateNY

VIII. Authorized Official

Name: ABRAHAM BENCHABBAT
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 718-218-8357