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General NPI Number Information
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NPI Number | 1689971616
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Entity Type | Organization
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Legal Business Name | FLATBUSH MEDICAL PC
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 1576 FLATBUSH AVE
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City | BROOKLYN
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State | NY
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Zip | 11210-3030
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Country | US
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Telephone | 347-533-8530
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Fax | 347-533-8533
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Provider Business Mailing Address
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Address Line | 1576 FLATBUSH AVE
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City | BROOKLYN
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State | NY
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Zip | 11210-3030
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Country | US
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Telephone | 347-533-8530
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Fax | 347-533-8533
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ERNESTO LOPEZ
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Credential | MD
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Telephone | 347-533-8530
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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 | 123637
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License Number State | NY
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