Healthcare Provider Details

I. General information

NPI: 1932890035
Provider Name (Legal Business Name): BELLA DJOUEJATI MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BELLA SEROR MSED

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 MCDONALD AVE
BROOKLYN NY
11223-2940
US

IV. Provider business mailing address

1856 E 9TH ST
BROOKLYN NY
11223-3237
US

V. Phone/Fax

Practice location:
  • Phone: 917-873-1601
  • Fax:
Mailing address:
  • Phone: 917-873-1601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2931856
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: