MEDICARE: MIDWOOD COMPLETE 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	207R00000X	Internal Medicine Physician	126720-1	NY

General Provider Information

NPI Number	:	1790001949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWOOD COMPLETE MEDICAL PC

Provider Business Mailing Address
First Line	:	1723 ELM AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5306
Country	:	US
Telephone Number	:	718-421-9630
Fax Number	:	718-998-9059

Provider Business Practice Location Address
First Line	:	1723 ELM AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5306
Country	:	US
Telephone Number	:	718-421-9630
Fax Number	:	718-998-9059

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NARCISSE VERSAILLES
Credential	:	MD
Telephone Number	:	718-421-9630

Provider Enumeration Date	:	04/13/2010
Last Update Date	:	04/13/2010

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Directions to “MIDWOOD COMPLETE MEDICAL PC ” Practice Location

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