Healthcare Provider Details

I. General information

NPI: 1992986871
Provider Name (Legal Business Name): SPRING CREEK MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 PENNSYLVANIA AVE SUITE 300
BROOKLYN NY
11239-2103
US

IV. Provider business mailing address

1390 PENNSYLVANIA AVE SUITE 300
BROOKLYN NY
11239-2103
US

V. Phone/Fax

Practice location:
  • Phone: 718-642-6200
  • Fax: 718-642-2178
Mailing address:
  • Phone: 718-642-6200
  • Fax: 718-642-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number126914-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number179324-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number179324-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number126914-1
License Number StateNY

VIII. Authorized Official

Name: DR. PREM C GOEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-642-6200