Healthcare Provider Details

I. General information

NPI: 1689582587
Provider Name (Legal Business Name): MOMENTUM HEALTH MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2234 E 14TH ST
BROOKLYN NY
11229-4313
US

IV. Provider business mailing address

116 SANDFORD ST
BROOKLYN NY
11205-2987
US

V. Phone/Fax

Practice location:
  • Phone: 929-308-0959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRO LATI
Title or Position: OWNER
Credential:
Phone: 347-439-1945