Healthcare Provider Details

I. General information

NPI: 1255642799
Provider Name (Legal Business Name): NOBLE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E 14TH ST
BROOKLYN NY
11229-1104
US

IV. Provider business mailing address

PO BOX 10454
UNIONDALE NY
11555-0454
US

V. Phone/Fax

Practice location:
  • Phone: 718-336-9100
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY GETTENBERG
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 516-569-1785