MEDICARE: AIR ATLANTIC 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	2084N0400X	Neurology Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1427506518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIR ATLANTIC MEDICAL PC

Provider Business Mailing Address
First Line	:	115 BRIGHTWATER CT STE 1G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7629
Country	:	US
Telephone Number	:	718-975-7690
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 BRIGHTWATER CT STE 1G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7629
Country	:	US
Telephone Number	:	718-975-7690
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ALEXANDER KANTOR
Credential	:
Telephone Number	:	718-975-7690

Provider Enumeration Date	:	09/17/2016
Last Update Date	:	11/15/2016

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Directions to “AIR ATLANTIC MEDICAL PC ” Practice Location

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