MEDICARE: AVE J 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	207Q00000X	Family Medicine Physician	212382	NY

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
2	33D0963294	OTHER	NY	CLIA #
3	212382	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1689828287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVE J MEDICAL PC

Provider Business Mailing Address
First Line	:	4010 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4440
Country	:	US
Telephone Number	:	718-338-1166
Fax Number	:	718-951-7550

Provider Business Practice Location Address
First Line	:	4010 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4440
Country	:	US
Telephone Number	:	718-338-1166
Fax Number	:	718-951-7550

Authorized Official
Title or Position	:	ADMIN
Name	:	LEONID E TAFLER
Credential	:	D.O.
Telephone Number	:	718-338-1166

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	03/07/2023

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Directions to “AVE J MEDICAL PC ” Practice Location

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