Healthcare Provider Details

I. General information

NPI: 1104079722
Provider Name (Legal Business Name): BROOKLYN BRIDGE MEDICAL ASSOCIATES. PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3632 NOSTRAND AVE
BROOKLYN NY
11229-5303
US

IV. Provider business mailing address

PO BOX 29083
NEW YORK NY
10087-9083
US

V. Phone/Fax

Practice location:
  • Phone: 201-857-4011
  • Fax:
Mailing address:
  • Phone: 201-857-4011
  • Fax: 201-389-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number243540-1
License Number StateNY

VIII. Authorized Official

Name: DR. HUMAIRA ZAFAR
Title or Position: DIRECTOR
Credential: M.D.
Phone: 201-857-4011