Healthcare Provider Details

I. General information

NPI: 1740527985
Provider Name (Legal Business Name): KINGSWAY MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 KINGS HWY
BROOKLYN NY
11229-1805
US

IV. Provider business mailing address

2414 AVENUE R
BROOKLYN NY
11229-2430
US

V. Phone/Fax

Practice location:
  • Phone: 917-859-3248
  • Fax:
Mailing address:
  • Phone: 917-859-3248
  • Fax: 212-208-2657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number158543
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number158543
License Number StateNY

VIII. Authorized Official

Name: DR. JEFFREY S BEN-ZVI
Title or Position: MEMBER
Credential: M.D.
Phone: 917-859-3248