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General NPI Number Information
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NPI Number | 1083902944
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Entity Type | Organization
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Legal Business Name | FLATBUSH FAMILY MEDICINE, P.C.
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Dates
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Enumeration Date | 07/13/2011
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Last Update Date | 07/13/2011
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Provider Practice Location Address
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Address Line | 595 FLATBUSH AVE
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City | BROOKLYN
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State | NY
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Zip | 11225-4903
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Country | US
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Telephone | 718-856-2800
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Fax | 718-282-8903
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Provider Business Mailing Address
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Address Line | 595 FLATBUSH AVE
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City | BROOKLYN
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State | NY
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Zip | 11225-4903
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Country | US
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Telephone | 718-856-2800
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Fax | 718-282-8903
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. TEOFILA M MALANUM
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Credential | M.D
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Telephone | 718-856-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 130479
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License Number State | NY
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