Healthcare Provider Details

I. General information

NPI: 1417245077
Provider Name (Legal Business Name): NEIGHBORHOOD MEDICAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 12/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 FLUSHING AVE
BROOKLYN NY
11206-4419
US

IV. Provider business mailing address

P O BOX 60157
BROOKLYN NY
11206-4107
US

V. Phone/Fax

Practice location:
  • Phone: 718-387-7300
  • Fax: 718-387-9700
Mailing address:
  • Phone: 718-387-7300
  • Fax: 718-387-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OLUYEMI O BADERO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-387-7300