Healthcare Provider Details

I. General information

NPI: 1629443353
Provider Name (Legal Business Name): BROOKDALE FAMILY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 NEW LOTS AVENUE BFCC NEW LOTS
BROOKLYN NY
11207-6414
US

IV. Provider business mailing address

1 BROOKDALE PLAZA 5TH FLOOR STRAUSBERG
BROOKLYN NY
11212
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-8950
  • Fax:
Mailing address:
  • Phone: 718-240-6374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number281467
License Number StateNY

VIII. Authorized Official

Name: CHARLES SALVO
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 718-240-6374