Basic Information
| Provider Information | |||||||||
| NPI: | 1013080126 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL BROOKLYN MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 345 SCHERMERHORN ST | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112171025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184033519 | ||||||||
| FaxNumber: | 7184033515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2832 LINDEN BLVD | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112085132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182402000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MAZZA | ||||||||
| AuthorizedOfficialFirstName: | LUCILLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASST COO | ||||||||
| AuthorizedOfficialTelephone: | 7184033519 | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 239419-1 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.