MEDICARE: UNIVERSITY PHYSICIANS OF BROOKLYN, INC.

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1477954469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY PHYSICIANS OF BROOKLYN, INC.

Provider Business Mailing Address
First Line	:	450 CLARKSON AVE
Second Line	:	MSC#80
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2012
Country	:	US
Telephone Number	:	718-613-8481
Fax Number	:	718-613-8498

Provider Business Practice Location Address
First Line	:	9202 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-7407
Country	:	US
Telephone Number	:	718-270-2045
Fax Number	:	718-270-2393

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MARILYN VIENTOS-SOTIRIADIS
Credential	:
Telephone Number	:	718-270-2025

Provider Enumeration Date	:	09/09/2014
Last Update Date	:	09/09/2014

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