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General NPI Number Information
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NPI Number | 1316072325
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Entity Type | Organization
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Legal Business Name | POLYMED COMMUNITY CARE,PC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 282 AVENUE X
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City | BROOKLYN
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State | NY
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Zip | 11223-5934
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Country | US
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Telephone | 718-645-2335
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Fax | 718-645-3404
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Provider Business Mailing Address
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Address Line | 282 AVENUE X
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City | BROOKLYN
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State | NY
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Zip | 11223-5934
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Country | US
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Telephone | 718-645-2335
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Fax | 718-645-3404
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Authorized Official
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Title or Position | INTERNAL MEDICINE
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Name | DR. SERGEY PETROV
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Credential | M.D
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Telephone | 718-645-2335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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