Healthcare Provider Details

I. General information

NPI: 1861780751
Provider Name (Legal Business Name): AF MEDICAL OF FLATBUSH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1386 FLATBUSH AVE
BROOKLYN NY
11210-1353
US

IV. Provider business mailing address

1386 FLATBUSH AVE
BROOKLYN NY
11210-1353
US

V. Phone/Fax

Practice location:
  • Phone: 917-652-4020
  • Fax: 917-652-4022
Mailing address:
  • Phone: 917-652-4020
  • Fax: 917-652-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number245705
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number239247
License Number State

VIII. Authorized Official

Name: LEONID ISAKOV
Title or Position: PRESIDENT
Credential: MD
Phone: 917-652-4020