Healthcare Provider Details

I. General information

NPI: 1184712341
Provider Name (Legal Business Name): CENTRAL BROOKLYN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SCHERMERHORN ST
BROOKLYN NY
11217-1025
US

IV. Provider business mailing address

345 SCHERMERHORN ST
BROOKLYN NY
11217-1025
US

V. Phone/Fax

Practice location:
  • Phone: 718-403-3519
  • Fax:
Mailing address:
  • Phone: 718-403-3519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number239572
License Number StateNY

VIII. Authorized Official

Name: MS. LUCILLE MAZZA
Title or Position: ASST COO
Credential:
Phone: 718-403-3519