MEDICARE: KINGS COUNTY PHYSICIANS GROUP 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	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1306489380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS COUNTY PHYSICIANS GROUP PLLC

Provider Business Mailing Address
First Line	:	1762 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6907
Country	:	US
Telephone Number	:	718-872-7358
Fax Number	:

Provider Business Practice Location Address
First Line	:	1762 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6907
Country	:	US
Telephone Number	:	718-872-7358
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ASHRAF SALEM
Credential	:	MD
Telephone Number	:	212-920-9212

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	02/14/2020

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