MEDICARE: CROSS COUNTY MEDICAL PC

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	207RC0000X	Cardiovascular Disease Physician
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5506981	OTHER		GHI

General Provider Information

NPI Number	:	1306839931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSS COUNTY MEDICAL PC

Provider Business Mailing Address
First Line	:	1262 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5102
Country	:	US
Telephone Number	:	718-859-5843
Fax Number	:	718-859-6284

Provider Business Practice Location Address
First Line	:	1262 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5102
Country	:	US
Telephone Number	:	718-859-5843
Fax Number	:	718-859-6284

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JUDAH AZRIEL CHARNOFF
Credential	:	MD
Telephone Number	:	718-859-5843

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	12/06/2007

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Directions to “CROSS COUNTY MEDICAL PC ” Practice Location

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