MEDICARE: GOOD HEALTH MEDICAL OF BROOKLYN, 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
1	207R00000X	Internal Medicine Physician	199964	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1018720	OTHER	NY	FIDELIS CARE
2	432740N	OTHER	NY	CIGNA
3	87093	OTHER	NY	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	199964	OTHER	NY	HIP
6	2C9154	OTHER	NY	HEALTHNET
7	005908	OTHER	NY	METROPLUS
8	45J051	OTHER	NY	BCBS
9	137603	OTHER	NY	WELCARE
10	P683045	OTHER	NY	OXFORD
11	N130940	OTHER	NY	1199
12	10111	OTHER	NY	ELDERPALN
13	2597940	OTHER	NY	GHI
14	45J051	OTHER	NY	MAGNACARE

General Provider Information

NPI Number	:	1972774990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD HEALTH MEDICAL OF BROOKLYN, P.C.

Provider Business Mailing Address
First Line	:	2026 OCEAN AVE
Second Line	:	SUITE 1B
City	:	BROOKLYN
State	:	NY
Zip	:	11230-7352
Country	:	US
Telephone Number	:	718-645-9236
Fax Number	:

Provider Business Practice Location Address
First Line	:	2026 OCEAN AVE
Second Line	:	SUITE 1B
City	:	BROOKLYN
State	:	NY
Zip	:	11230-7352
Country	:	US
Telephone Number	:	718-645-9236
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEO YANKILEVICH
Credential	:	M.D.
Telephone Number	:	718-645-9236

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	03/18/2008

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