Healthcare Provider Details

I. General information

NPI: 1790074326
Provider Name (Legal Business Name): MEDICAL HEALTH 4 ALL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 BRIGHTON 6 STREET
BROOKLYN NY
11235
US

IV. Provider business mailing address

PO BOX 351145
BROOKLYN NY
11235-8945
US

V. Phone/Fax

Practice location:
  • Phone: 718-704-9909
  • Fax:
Mailing address:
  • Phone: 718-907-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number252520
License Number StateNY

VIII. Authorized Official

Name: DR. MIKHAIL KOROGLUYEV
Title or Position: PRESIDENT
Credential: D.O.
Phone: 718-704-9909