Healthcare Provider Details

I. General information

NPI: 1982750360
Provider Name (Legal Business Name): SEBHATU TEWOLDE GEBREZGI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9408 FLATLANDS AVE
BROOKLYN NY
11236
US

IV. Provider business mailing address

9408 FLATLANDS AVE
BROOKLYN NY
11236
US

V. Phone/Fax

Practice location:
  • Phone: 718-272-0977
  • Fax: 718-272-1088
Mailing address:
  • Phone: 718-272-0977
  • Fax: 718-272-1088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number196278
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number196278
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: