MEDICARE: BROOKLYN BRIDGE MEDICAL ASSOCIATES. PLLC.

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	207L00000X	Anesthesiology Physician	243540-1	NY

General Provider Information

NPI Number	:	1104079722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN BRIDGE MEDICAL ASSOCIATES. PLLC.

Provider Business Mailing Address
First Line	:	PO BOX 29083
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-9083
Country	:	US
Telephone Number	:	201-857-4011
Fax Number	:	201-389-3498

Provider Business Practice Location Address
First Line	:	3632 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5303
Country	:	US
Telephone Number	:	201-857-4011
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. HUMAIRA ZAFAR
Credential	:	M.D.
Telephone Number	:	201-857-4011

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	12/20/2011

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