Healthcare Provider Details

I. General information

NPI: 1740243898
Provider Name (Legal Business Name): JERZY M MACURA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 48TH ST 2ND FLOOR
BROOKLYN NY
11219-2918
US

IV. Provider business mailing address

948 48TH ST 2ND FLOOR
BROOKLYN NY
11219-2918
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-7602
  • Fax: 718-635-7226
Mailing address:
  • Phone: 718-283-7602
  • Fax: 718-635-7226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number179919
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: