Healthcare Provider Details

I. General information

NPI: 1922247592
Provider Name (Legal Business Name): BROOKLYN INTEGRATED MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 KIMBALL ST
BROOKLYN NY
11234-5139
US

IV. Provider business mailing address

2270 KIMBALL ST
BROOKLYN NY
11234-5139
US

V. Phone/Fax

Practice location:
  • Phone: 718-332-4080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number165127
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number173570
License Number StateNY

VIII. Authorized Official

Name: DR. JUDE BARBERA
Title or Position: PARTNER
Credential: MD
Phone: 718-332-4080