Healthcare Provider Details

I. General information

NPI: 1043752785
Provider Name (Legal Business Name): STARRETT CITY MEDICAL OF NEW YORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 FLATBUSH AVE
BROOKLYN NY
11226-4018
US

IV. Provider business mailing address

924 FLATBUSH AVE
BROOKLYN NY
11226-4018
US

V. Phone/Fax

Practice location:
  • Phone: 718-301-1100
  • Fax: 224-246-8042
Mailing address:
  • Phone: 718-301-1100
  • Fax: 224-246-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: FLORA KATSNELSON
Title or Position: DIRECTOR
Credential: MD
Phone: 847-257-1244