Basic Information
| Provider Information | |||||||||
| NPI: | 1912541061 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AJS BROOKLYN MEDICAL PRACTICE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6255 W SUNSET BLVD FL 21 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900287422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234986686 | ||||||||
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| Practice Location | |||||||||
| Address1: | 475 ATLANTIC AVE STE 2 | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112174383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183694850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2019 | ||||||||
| LastUpdateDate: | 03/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | HONIG | ||||||||
| AuthorizedOfficialFirstName: | LYLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3238605244 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 207RI0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.