Healthcare Provider Details

I. General information

NPI: 1922409754
Provider Name (Legal Business Name): BROOKLYN MEDICAL & SURGICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 E 19TH ST
BROOKLYN NY
11230-7203
US

IV. Provider business mailing address

1575 E 19TH ST
BROOKLYN NY
11230-7203
US

V. Phone/Fax

Practice location:
  • Phone: 917-325-0349
  • Fax: 201-389-3498
Mailing address:
  • Phone: 917-325-0349
  • Fax: 201-389-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number5095
License Number StateNY

VIII. Authorized Official

Name: DR. NORMAN SVEILICH
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 917-525-3067