Healthcare Provider Details

I. General information

NPI: 1124344627
Provider Name (Legal Business Name): COBBLE HILL GYNECOLOGY FPP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 JORALEMON ST
BROOKLYN NY
11201-4326
US

IV. Provider business mailing address

186 JORALEMON ST
BROOKLYN NY
11201-4326
US

V. Phone/Fax

Practice location:
  • Phone: 718-858-5000
  • Fax: 718-858-5095
Mailing address:
  • Phone: 718-858-5000
  • Fax: 718-858-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number206491
License Number StateNY

VIII. Authorized Official

Name: VICTORIA FALCONE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 718-283-8864