Healthcare Provider Details

I. General information

NPI: 1992711444
Provider Name (Legal Business Name): BROOKLYN PLAZA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 FULTON ST
BROOKLYN NY
11217-1517
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 718-596-9800
  • Fax: 718-596-9889
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number1942461
License Number StateNY

VIII. Authorized Official

Name: FRANCK LEVEILLE
Title or Position: MEDICAL DIR
Credential:
Phone: 718-596-9800