Healthcare Provider Details

I. General information

NPI: 1104896430
Provider Name (Legal Business Name): BROOKLYN ENDOSCOPY AND AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E 14TH ST
BROOKLYN NY
11229-1104
US

IV. Provider business mailing address

1630 E 14TH ST
BROOKLYN NY
11229-1104
US

V. Phone/Fax

Practice location:
  • Phone: 718-336-9100
  • Fax: 718-336-2328
Mailing address:
  • Phone: 718-336-9100
  • Fax: 718-336-2328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7001115R
License Number StateNY

VIII. Authorized Official

Name: MRS. LYNN GETTENBERG
Title or Position: EXCECUTIVE DIRECTOR
Credential:
Phone: 718-336-9100