Healthcare Provider Details

I. General information

NPI: 1871017905
Provider Name (Legal Business Name): SEABREEZE ENDOSCOPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W BRIGHTON AVE STE 104
BROOKLYN NY
11224-4901
US

IV. Provider business mailing address

40 W BRIGHTON AVE STE 104
BROOKLYN NY
11224-4901
US

V. Phone/Fax

Practice location:
  • Phone: 718-627-8300
  • Fax: 718-627-8302
Mailing address:
  • Phone: 718-627-8300
  • Fax: 718-627-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number211765
License Number StateNY

VIII. Authorized Official

Name: IRINA BERLIN
Title or Position: MD
Credential:
Phone: 718-627-8300