MEDICARE: VARICOSE CARE 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	2085R0202X	Diagnostic Radiology Physician	219737	NY
2	2085R0204X	Vascular & Interventional Radiology Physician	219737	NY
3	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1821361312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VARICOSE CARE MEDICAL PC

Provider Business Mailing Address
First Line	:	612 CORPORATE WAY STE 2M
Second Line	:
City	:	VALLEY COTTAGE
State	:	NY
Zip	:	10989-2027
Country	:	US
Telephone Number	:	718-362-8182
Fax Number	:	718-414-1651

Provider Business Practice Location Address
First Line	:	2401 AVENUE O
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5134
Country	:	US
Telephone Number	:	718-362-8182
Fax Number	:	718-414-1651

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	DESIREE BROWN
Credential	:
Telephone Number	:	718-362-8182

Provider Enumeration Date	:	02/15/2012
Last Update Date	:	02/15/2022

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