Healthcare Provider Details

I. General information

NPI: 1063747236
Provider Name (Legal Business Name): USA MEDICAL OF NEW YORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 OCEAN AVE STE 102
BROOKLYN NY
11229-3957
US

IV. Provider business mailing address

2511 OCEAN AVE STE 102
BROOKLYN NY
11229-3957
US

V. Phone/Fax

Practice location:
  • Phone: 718-301-1100
  • Fax: 718-301-1099
Mailing address:
  • Phone: 718-301-1100
  • Fax: 718-301-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2427581
License Number StateNY

VIII. Authorized Official

Name: DR. FLORA KATSNELSON
Title or Position: OWNER
Credential: MD
Phone: 718-301-1100