Healthcare Provider Details

I. General information

NPI: 1104112838
Provider Name (Legal Business Name): KINGSBROOK MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1851
US

IV. Provider business mailing address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1851
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5532
  • Fax:
Mailing address:
  • Phone: 718-604-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number7001033H
License Number StateNY

VIII. Authorized Official

Name: JOHN SCHMITT
Title or Position: SVPF
Credential:
Phone: 718-604-5000