Healthcare Provider Details

I. General information

NPI: 1881071991
Provider Name (Legal Business Name): SPECIAL CARE MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 PENNSYLVANIA AVE SUITE 5
BROOKLYN NY
11207-3436
US

IV. Provider business mailing address

725 E 22ND ST
BROOKLYN NY
11210-1103
US

V. Phone/Fax

Practice location:
  • Phone: 718-421-0472
  • Fax:
Mailing address:
  • Phone: 718-421-0472
  • Fax:

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 Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROGELIO THOMAS
Title or Position: PRESIDENT
Credential: MD
Phone: 718-421-0472