Healthcare Provider Details

I. General information

NPI: 1306839931
Provider Name (Legal Business Name): CROSS COUNTY MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 OCEAN PKWY
BROOKLYN NY
11230-5102
US

IV. Provider business mailing address

1262 OCEAN PKWY
BROOKLYN NY
11230-5102
US

V. Phone/Fax

Practice location:
  • Phone: 718-859-5843
  • Fax: 718-859-6284
Mailing address:
  • Phone: 718-859-5843
  • Fax: 718-859-6284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JUDAH AZRIEL CHARNOFF
Title or Position: PRESIDENT
Credential: MD
Phone: 718-859-5843