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Specialty details in registry · Brooklyn, NY

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At a glance

4310-12 Church Avenue, Brooklyn, NY 11203

NPPES record updated Oct 30, 2014. Public records can lag behind changes at a practice.

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Practice location

4310-12 Church Avenue
Brooklyn, NY 11203
Professional details: NPI, taxonomy & registry record
NPI1730584947
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
2081P2900X
Enumeration date
Oct 30, 2014
Record updated
Oct 30, 2014
More registry details
Provider type
Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

2081P2900X · Primary

License reported: 60-189163 NY

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

4310-12 Church Avenue
Brooklyn, NY 11203
Phone
(718) 287-1000
Fax
(718) 287-1033
Mailing address
4310-12 CHURCH AVENUE

BROOKLYN, NY 11203
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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