Healthcare Provider Details

I. General information

NPI: 1659516375
Provider Name (Legal Business Name): BROOKLYN ENDOSCOPY SC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 EMMONS AVE
BROOKLYN NY
11235-2792
US

IV. Provider business mailing address

2211 EMMONS AVE
BROOKLYN NY
11235-2792
US

V. Phone/Fax

Practice location:
  • Phone: 718-954-3535
  • Fax: 718-954-3548
Mailing address:
  • Phone: 718-954-3535
  • Fax: 718-954-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SCOTT TENNER
Title or Position: DIRECTOR
Credential: MD
Phone: 718-954-3535