Healthcare Provider Details

I. General information

NPI: 1902486715
Provider Name (Legal Business Name): BRIGHTON PEDIATRIC CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 BANNER AVE
BROOKLYN NY
11235-6957
US

IV. Provider business mailing address

706 BANNER AVE
BROOKLYN NY
11235-6957
US

V. Phone/Fax

Practice location:
  • Phone: 718-368-3092
  • Fax:
Mailing address:
  • Phone: 718-368-3092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SHILA MOMTAJ
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 718-368-3092