Healthcare Provider Details

I. General information

NPI: 1932183258
Provider Name (Legal Business Name): GETAHUN KIFLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 LINCOLN PL
BROOKLYN NY
11238-6202
US

IV. Provider business mailing address

486 LINCOLN PLACE
BROOKLYN NY
11238
US

V. Phone/Fax

Practice location:
  • Phone: 718-463-1100
  • Fax: 718-462-1900
Mailing address:
  • Phone: 718-462-1100
  • Fax: 718-462-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number209314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: