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General NPI Number Information
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NPI Number | 1851662431
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Entity Type | Organization
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Legal Business Name | BRIDGEVIEW NEUROMED CARE PC
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 829 57TH ST 5FL
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City | BROOKLYN
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State | NY
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Zip | 11220-3677
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Country | US
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Telephone | 718-375-3738
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Fax | 718-686-0188
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Provider Business Mailing Address
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Address Line | 829 57TH ST 5FL
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City | BROOKLYN
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State | NY
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Zip | 11220-3677
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Country | US
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Telephone | 718-375-3738
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Fax | 718-686-0188
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Authorized Official
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Title or Position | PRESIDENT
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Name | YONGMING MAO
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Credential | M.D
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Telephone | 718-375-3738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 233817
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License Number State | NY
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