Healthcare Provider Details

I. General information

NPI: 1235228719
Provider Name (Legal Business Name): KINGSWAY INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 BATCHELDER ST 1L
BROOKLYN NY
11235-1453
US

IV. Provider business mailing address

2525 BATCHELDER ST 1L
BROOKLYN NY
11235-1453
US

V. Phone/Fax

Practice location:
  • Phone: 718-891-1500
  • Fax: 718-891-2068
Mailing address:
  • Phone: 718-891-1500
  • Fax: 718-891-2068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number083819
License Number StateNY

VIII. Authorized Official

Name: STANLEY NEWHOUSE
Title or Position: OWNER
Credential: MD
Phone: 718-891-1500