Healthcare Provider Details

I. General information

NPI: 1285940148
Provider Name (Legal Business Name): BROOKLYN COMPREHENSIVE CARE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2010
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 CHURCH AVE
BROOKLYN NY
11203-3209
US

IV. Provider business mailing address

4711 CHURCH AVE
BROOKLYN NY
11203-3209
US

V. Phone/Fax

Practice location:
  • Phone: 917-364-0801
  • Fax: 516-629-6258
Mailing address:
  • Phone: 917-364-0801
  • Fax: 516-629-6258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number234776
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number234776
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number234776
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number234776
License Number StateNY

VIII. Authorized Official

Name: SYED I AHMED
Title or Position: CEO
Credential:
Phone: 917-364-0801