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NPI Code Detail

MEDICARE: FAMILY MEDICAL CARE OF MARINE PARK, P.C.

MEDICARE: FAMILY MEDICAL CARE OF MARINE PARK, P.C.
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1902004484
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY MEDICAL CARE OF MARINE PARK, P.C.
Provider Business Mailing Address
First Line : 2915 AVENUE S
Second Line :
City : BROOKLYN
State : NY
Zip : 11229
Country : US
Telephone Number : 718-998-9669
Fax Number : 718-339-5614
Provider Business Practice Location Address
First Line : 2915 AVENUE S
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-2544
Country : US
Telephone Number : 718-998-9669
Fax Number : 718-339-5614
Authorized Official
Title or Position : PRESIDENT
Name : DR. EUGENE JOHN MANCUSO
Credential : MD
Telephone Number : 718-998-9669
Provider Enumeration Date : 07/06/2007
Last Update Date : 05/28/2014

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Directions to “FAMILY MEDICAL CARE OF MARINE PARK, P.C. ” Practice Location

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