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General NPI Number Information
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NPI Number | 1548430325
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Entity Type | Organization
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Legal Business Name | BROOKLYN MEDICAL HEALTH & WELLNESS, P.C.
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 3043 OCEAN AVE SUITE 104
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City | BROOKLYN
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State | NY
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Zip | 11235-3497
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Country | US
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Telephone | 718-332-7772
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Fax | 718-332-5329
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Provider Business Mailing Address
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Address Line | PO BOX 670618
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City | FLUSHING
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State | NY
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Zip | 11367-0618
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Country | US
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Telephone | 917-686-7564
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Fax | 718-261-7606
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Authorized Official
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Title or Position | CONTROLLER
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Name | MR. JACK LEONARD BAUMGARTEN
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Credential |
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Telephone | 917-686-7564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 206669
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License Number State | NY
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