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General NPI Number Information
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NPI Number | 1104112838
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Entity Type | Organization
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Legal Business Name | KINGSBROOK MEDICAL ASSOCIATES, PC
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 585 SCHENECTADY AVE
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City | BROOKLYN
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State | NY
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Zip | 11203-1851
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Country | US
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Telephone | 718-604-5532
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Fax |
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Provider Business Mailing Address
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Address Line | 585 SCHENECTADY AVE
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City | BROOKLYN
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State | NY
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Zip | 11203-1851
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Country | US
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Telephone | 718-604-5000
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Fax |
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Authorized Official
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Title or Position | SVPF
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Name | JOHN SCHMITT
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Credential |
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Telephone | 718-604-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 7001033H
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License Number State | NY
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