Healthcare Provider Details

I. General information

NPI: 1346527991
Provider Name (Legal Business Name): OPTIMAL BROOKLYN MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1753 BROADWAY
BROOKLYN NY
11207-1594
US

IV. Provider business mailing address

1753 BROADWAY
BROOKLYN NY
11207-1594
US

V. Phone/Fax

Practice location:
  • Phone: 718-452-2719
  • Fax: 718-452-2735
Mailing address:
  • Phone: 718-452-2719
  • Fax: 718-452-2735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ENRICO PALAZZO
Title or Position: MANAGER
Credential:
Phone: 718-452-2719