MEDICARE: PROSPECT HILLS MEDICAL CARE 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	207Q00000X	Family Medicine Physician	226995	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A100001474	OTHER	NY	MEDICARE PTAN

General Provider Information

NPI Number	:	1447285952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSPECT HILLS MEDICAL CARE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 210968
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-0968
Country	:	US
Telephone Number	:	718-443-2300
Fax Number	:	718-443-3350

Provider Business Practice Location Address
First Line	:	275 HULL ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-2906
Country	:	US
Telephone Number	:	718-443-2300
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	EMEFRE OSCAR-AMANAM UDO
Credential	:	MD
Telephone Number	:	718-443-2300

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/08/2013

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