Healthcare Provider Details

I. General information

NPI: 1952224404
Provider Name (Legal Business Name): HAILEMARYAM ALEMU ASTATK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKDALE PLZ
BROOKLYN NY
11212-3198
US

IV. Provider business mailing address

1545 ATLANTIC AVE
BROOKLYN NY
11213-1122
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-5000
  • Fax:
Mailing address:
  • Phone: 718-613-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: