MEDICARE: STATMDNY

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	261QE0002X	Emergency Care Clinic/Center
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1609410802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATMDNY

Provider Business Mailing Address
First Line	:	1911 E 29TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2534
Country	:	US
Telephone Number	:	347-880-2852
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 E 29TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2534
Country	:	US
Telephone Number	:	347-880-2852
Fax Number	:

Authorized Official
Title or Position	:	OPERATOR
Name	:	JOEL SCHWARTZ
Credential	:
Telephone Number	:	347-880-2852

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	10/30/2019

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Directions to “STATMDNY ” Practice Location

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