Healthcare Provider Details

I. General information

NPI: 1992642334
Provider Name (Legal Business Name): KINGS SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 66TH ST
BROOKLYN NY
11204-3861
US

IV. Provider business mailing address

1807 66TH ST
BROOKLYN NY
11204-3861
US

V. Phone/Fax

Practice location:
  • Phone: 347-592-1120
  • Fax: 800-550-4779
Mailing address:
  • Phone: 347-592-1120
  • Fax: 800-550-4779

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: BRIAN S PUN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 347-592-1120