MEDICARE: KINGSWAY INTERNAL MEDICINE

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	083819	NY
2	207R00000X	Internal Medicine Physician

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	:	1235228719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGSWAY INTERNAL MEDICINE

Provider Business Mailing Address
First Line	:	2525 BATCHELDER ST
Second Line	:	1L
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1453
Country	:	US
Telephone Number	:	718-891-1500
Fax Number	:	718-891-2068

Provider Business Practice Location Address
First Line	:	2525 BATCHELDER ST
Second Line	:	1L
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1453
Country	:	US
Telephone Number	:	718-891-1500
Fax Number	:	718-891-2068

Authorized Official
Title or Position	:	OWNER
Name	:	STANLEY NEWHOUSE
Credential	:	MD
Telephone Number	:	718-891-1500

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	04/22/2008

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Directions to “KINGSWAY INTERNAL MEDICINE ” Practice Location

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