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General NPI Number Information
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NPI Number | 1477888980
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Entity Type | Organization
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Legal Business Name | BROOKLYN SELECT PHYSICIAN
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 170-12 HIGHLAND AVE, SUITE102
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City | JAMAICA
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State | NY
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Zip | 11432
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Country | US
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Telephone | 718-233-4966
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Fax | 718-622-2323
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Provider Business Mailing Address
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Address Line | 1078 FULTON STREET, 1ST FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11238
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Country | US
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Telephone | 718-622-2300
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Fax | 718-622-2323
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Authorized Official
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Title or Position | CEO
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Name | SAMIA TAYAB
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Credential | MD
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Telephone | 917-405-6727
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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 | 217560
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 212345
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License Number State | NY
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