MEDICARE: CENTRAL BROOKLYN MEDICAL GROUP PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207N00000X	Dermatology Physician
2	207R00000X	Internal Medicine Physician
3	207RH0003X	Hematology & Oncology Physician
4	207RI0011X	Interventional Cardiology Physician
5	207RN0300X	Nephrology Physician
6	207T00000X	Neurological Surgery Physician
7	207V00000X	Obstetrics & Gynecology Physician
8	207W00000X	Ophthalmology Physician
9	207X00000X	Orthopaedic Surgery Physician
10	207Y00000X	Otolaryngology Physician
11	208000000X	Pediatrics Physician
12	208600000X	Surgery Physician
13	208800000X	Urology Physician
14	261QR0200X	Radiology Clinic/Center
15	207KA0200X	Allergy Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689627184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL BROOKLYN MEDICAL GROUP PC

Provider Business Mailing Address
First Line	:	441 9TH AVE
Second Line	:	9TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10001-1623
Country	:	US
Telephone Number	:	646-680-2894
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 9TH AVE
Second Line	:	9TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10001-1623
Country	:	US
Telephone Number	:	646-680-2894
Fax Number	:

Authorized Official
Title or Position	:	AVP - CREDENTIALING
Name	:	MARLENA SIMPSON
Credential	:	CPMSM
Telephone Number	:	646-680-2894

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	06/04/2015

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