Healthcare Provider Details

I. General information

NPI: 1225099476
Provider Name (Legal Business Name): BROOKLYN PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLOUGHBY ST
BROOKLYN NY
11201-5465
US

IV. Provider business mailing address

635 2ND ST
BROOKLYN NY
11215-2601
US

V. Phone/Fax

Practice location:
  • Phone: 718-768-1906
  • Fax: 718-788-5192
Mailing address:
  • Phone: 718-768-1906
  • Fax: 718-788-5192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN MAKOWER
Title or Position: DIRECTOR
Credential: MD
Phone: 718-768-1906