Healthcare Provider Details

I. General information

NPI: 1770707622
Provider Name (Legal Business Name): 5000 AVENUE K MEDICAL ASSOCS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 AVENUE K
BROOKLYN NY
11234-3225
US

IV. Provider business mailing address

1987 UTICA AVENUE
BROOKLYN NY
11234-3225
US

V. Phone/Fax

Practice location:
  • Phone: 718-968-1515
  • Fax: 718-209-2295
Mailing address:
  • Phone: 718-629-5590
  • Fax: 718-629-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. STEVEN C ACKERMAN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 718-629-5590