MEDICARE: 5000 AVENUE K MEDICAL ASSOCS 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	207L00000X	Anesthesiology 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	:	1770707622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5000 AVENUE K MEDICAL ASSOCS PC

Provider Business Mailing Address
First Line	:	1987 UTICA AVENUE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3225
Country	:	US
Telephone Number	:	718-629-5590
Fax Number	:	718-629-2833

Provider Business Practice Location Address
First Line	:	5000 AVENUE K
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3225
Country	:	US
Telephone Number	:	718-968-1515
Fax Number	:	718-209-2295

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MR. STEVEN C ACKERMAN
Credential	:
Telephone Number	:	718-629-5590

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	06/13/2024

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