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General NPI Number Information
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NPI Number | 1912007063
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Entity Type | Organization
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Legal Business Name | PHOENIX MEDICAL CENTER INC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 341 KNICKERBOCKER AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-3740
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Country | US
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Telephone | 718-386-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 29 STEVEN LN
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City | GREAT NECK
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State | NY
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Zip | 11024-1534
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Country | US
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Telephone | 718-386-1100
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SOSHANA CITRIN
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Credential |
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Telephone | 718-386-1100
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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 |
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License Number State |
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