Healthcare Provider Details

I. General information

NPI: 1992975304
Provider Name (Legal Business Name): TRIO UROLOGY ASSOCIATES SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 OCEAN AVE
BROOKLYN NY
11229-3916
US

IV. Provider business mailing address

2508 OCEAN AVE
BROOKLYN NY
11229-3916
US

V. Phone/Fax

Practice location:
  • Phone: 718-258-1800
  • Fax: 718-743-3944
Mailing address:
  • Phone: 718-258-1800
  • Fax: 718-743-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number113668
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number113668
License Number StateNY

VIII. Authorized Official

Name: ABRAHAM OSTAD
Title or Position: OWNER
Credential: M.D.
Phone: 718-258-1800