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General NPI Number Information
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NPI Number | 1871684753
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Entity Type | Organization
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Legal Business Name | BROOKLYN FAMILY MEDICAL CARE
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 60 PLAZA ST E SUITE E
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City | BROOKLYN
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State | NY
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Zip | 11238-5040
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Country | US
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Telephone | 718-783-3919
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 274
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City | MANHASSET
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State | NY
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Zip | 11030-0274
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Country | US
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Telephone | 516-627-3354
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLARK ROBERT LOPEZ
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Credential | MD
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Telephone | 718-783-3919
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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 | 117032
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License Number State | NY
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