Healthcare Provider Details

I. General information

NPI: 1235204447
Provider Name (Legal Business Name): BE HEALTHY MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 KINGS HWY 2ND FLOOR
BROOKLYN NY
11229-1960
US

IV. Provider business mailing address

1302 KINGS HWY 2ND FLOOR
BROOKLYN NY
11229-1960
US

V. Phone/Fax

Practice location:
  • Phone: 718-645-2700
  • Fax: 718-645-3188
Mailing address:
  • Phone: 718-645-2700
  • Fax: 718-645-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number211343
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDRA ETKIN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 718-648-2122