Healthcare Provider Details

I. General information

NPI: 1962459644
Provider Name (Legal Business Name): BROOKDALE FAMILY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 04/24/2024
Certification Date: 05/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 FLATBUSH AVE
BROOKLYN NY
11226-6141
US

IV. Provider business mailing address

BROOKDALE FAMILY CARE CENTER, INC. 1095 FLATBUSH AVE
BROOKLYN NY
11226-6141
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-8800
  • Fax:
Mailing address:
  • Phone: 718-240-8352
  • Fax: 718-240-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 10
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE FIGUEROA
Title or Position: CFO
Credential:
Phone: 718-240-7931