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General NPI Number Information
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NPI Number | 1114093523
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Entity Type | Organization
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Legal Business Name | SOUTH BROOKLYN MEDICAL ADMINISTRATIVE SERVICES, INC.
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 685 3RD AVE
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City | BROOKLYN
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State | NY
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Zip | 11232-1108
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Country | US
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Telephone | 718-788-2594
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Fax | 718-788-5848
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Provider Business Mailing Address
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Address Line | 685 3RD AVE
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City | BROOKLYN
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State | NY
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Zip | 11232-1108
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Country | US
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Telephone | 718-788-2594
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Fax | 347-529-4829
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | ALEXIS BOSCO
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Credential |
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Telephone | 718-788-2594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 7001121R
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License Number State | NY
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