MEDICARE: ALL CITY FAMILY HEALTHCARE CENTER, INC.

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	7001285R	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	:	1215939186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL CITY FAMILY HEALTHCARE CENTER, INC.

Provider Business Mailing Address
First Line	:	3632 NOSTRAND AVE
Second Line	:	GROUND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5303
Country	:	US
Telephone Number	:	718-332-4409
Fax Number	:	718-332-4472

Provider Business Practice Location Address
First Line	:	3632 NOSTRAND AVE
Second Line	:	GROUND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5303
Country	:	US
Telephone Number	:	718-332-4409
Fax Number	:	718-332-4472

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NASSER F HASSAN
Credential	:
Telephone Number	:	718-332-4409

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	11/04/2013

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