Healthcare Provider Details

I. General information

NPI: 1609873116
Provider Name (Legal Business Name): AMBULATORY SURGERY CENTER OF BROOKLYN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 43RD ST
BROOKLYN NY
11232-3609
US

IV. Provider business mailing address

313 43RD ST
BROOKLYN NY
11232-3609
US

V. Phone/Fax

Practice location:
  • Phone: 718-369-1900
  • Fax: 718-965-4157
Mailing address:
  • Phone: 718-369-1900
  • Fax: 718-965-4157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7001244R
License Number StateNY

VIII. Authorized Official

Name: MR. FRANCIS XAVIER MONCK
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-369-2140