Healthcare Provider Details

I. General information

NPI: 1225238686
Provider Name (Legal Business Name): TBHC MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEKALB AVE
BROOKLYN NY
11201-5425
US

IV. Provider business mailing address

121 DEKALB AVE
BROOKLYN NY
11201-5425
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-8663
  • Fax: 718-250-6850
Mailing address:
  • Phone: 718-250-8663
  • Fax: 718-250-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN CARROLL
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 718-250-6676