=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497377246
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL BROOKLYN PHYSICIAN PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2020
-----------------------------------------------------
Last Update Date | 05/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 387 LINDEN BLVD FL 1
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11203-2823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-425-0022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 387 LINDEN BLVD FL 1
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11203-2823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-425-0022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARGARET DONAT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 347-425-0022
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------