MEDICARE: BROOKLYN ENDOSCOPY AND AMBULATORY SURGERY CENTER, LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	7001115R	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104896430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN ENDOSCOPY AND AMBULATORY SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	1630 E 14TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1104
Country	:	US
Telephone Number	:	718-336-9100
Fax Number	:	718-336-2328

Provider Business Practice Location Address
First Line	:	1630 E 14TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1104
Country	:	US
Telephone Number	:	718-336-9100
Fax Number	:	718-336-2328

Authorized Official
Title or Position	:	EXCECUTIVE DIRECTOR
Name	:	MRS. LYNN GETTENBERG
Credential	:
Telephone Number	:	718-336-9100

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	08/22/2020

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