Healthcare Provider Details

I. General information

NPI: 1255675062
Provider Name (Legal Business Name): BROOKLYN SC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 BAY PARKWAY 4TH FLOOR
BROOKLYN NY
11204
US

IV. Provider business mailing address

6010 BAY PARKWAY 4TH FLOOR
BROOKLYN NY
11204
US

V. Phone/Fax

Practice location:
  • Phone: 718-259-4272
  • Fax: 718-259-1582
Mailing address:
  • Phone: 718-259-4272
  • Fax: 718-259-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER B. BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5954