Healthcare Provider Details

I. General information

NPI: 1487283503
Provider Name (Legal Business Name): ENITZA DAMARIS GEORGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 ROCKAWAY AVE
BROOKLYN NY
11212-5539
US

IV. Provider business mailing address

1277 E 14TH ST APT 711B
BROOKLYN NY
11230-5693
US

V. Phone/Fax

Practice location:
  • Phone: 718-345-5000
  • Fax:
Mailing address:
  • Phone: 715-202-0827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number322328
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: