Healthcare Provider Details

I. General information

NPI: 1750767570
Provider Name (Legal Business Name): EMNET BERHANU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 FULTON ST
BROOKLYN NY
11216-2505
US

IV. Provider business mailing address

2160 MATTHEWS AVE APT 4W
BRONX NY
10451
US

V. Phone/Fax

Practice location:
  • Phone: 718-636-4500
  • Fax: 718-296-8332
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number058803
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: