MEDICARE: AVENUE X PRIMARY MEDICAL CARE P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center		NY

General Provider Information

NPI Number	:	1053415661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVENUE X PRIMARY MEDICAL CARE P.C.

Provider Business Mailing Address
First Line	:	2727 CONEY ISLAND AVE STE 1B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5004
Country	:	US
Telephone Number	:	718-376-6500
Fax Number	:	718-376-5078

Provider Business Practice Location Address
First Line	:	2727 CONEY ISLAND AVE STE 1B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5004
Country	:	US
Telephone Number	:	718-376-6500
Fax Number	:	718-376-5078

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	LEV J. PAUKMAN, M.D.
Credential	:	MD
Telephone Number	:	718-376-6500

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	12/15/2025

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