Healthcare Provider Details

I. General information

NPI: 1295524270
Provider Name (Legal Business Name): BROOKE MICHELE MAHOSKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE STE O-4000
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

PO BOX 157
PLAINVIEW NY
11803-0157
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7330
  • Fax:
Mailing address:
  • Phone: 516-426-4652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: