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General NPI Number Information
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NPI Number | 1326699117
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Entity Type | Organization
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Legal Business Name | BROOKLYN MEDICAL SERVICES OF NY
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 1575 E 19TH ST
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City | BROOKLYN
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State | NY
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Zip | 11230-7203
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Country | US
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Telephone | 718-339-7500
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Fax | 718-228-6485
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Provider Business Mailing Address
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Address Line | 1575 E 19TH ST
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City | BROOKLYN
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State | NY
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Zip | 11230-7203
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Country | US
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Telephone | 718-339-7500
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Fax | 718-228-6485
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. WENDELL JOSEPH GORUM II
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Credential | M.D.
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Telephone | 718-339-7500
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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 |
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License Number State |
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