Healthcare Provider Details

I. General information

NPI: 1184630634
Provider Name (Legal Business Name): BEDFORD STUYVESANT FAM HLTH CTR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 FULTON ST
BROOKLYN NY
11216-2607
US

IV. Provider business mailing address

300 PENN CENTER BLVD STE 505
PITTSBURGH PA
15235-5511
US

V. Phone/Fax

Practice location:
  • Phone: 718-636-4500
  • Fax: 718-636-8275
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number130684
License Number StateNY

VIII. Authorized Official

Name: MONICA SWEENEY
Title or Position: MEDICAL DIR
Credential:
Phone: 718-636-4500