Basic Information
| Provider Information | |||||||||
| NPI: | 1558707299 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AJS BROOKLYN MEDICAL PRACTICE PC | ||||||||
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| OtherOrganizationName: | AJS BROOKLYN MEDICAL PRACTICE PC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6255 W SUNSET BLVD FL 21 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900287422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238605200 | ||||||||
| FaxNumber: | 8332417615 | ||||||||
| Practice Location | |||||||||
| Address1: | 475 ATLANTIC AVE | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112171812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183694850 | ||||||||
| FaxNumber: | 7183694851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2013 | ||||||||
| LastUpdateDate: | 08/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | HONIG | ||||||||
| AuthorizedOfficialFirstName: | LYLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3234365025 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.