Organization · NPI-2

1110 Pennsylvania Avenue Medical PLLC

Clinic/Center, Urgent Care · Brooklyn, NY

NPI number1730638115
StatusActive
Last updated in NPPESOct 5, 2016

Details

NPI
1730638115
Entity type
Organization (NPI-2)
Legal business name
1110 Pennsylvania Avenue Medical PLLC
Organization subpart
No
Enumeration date
Sep 27, 2016
Last updated
Oct 5, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QU0200X Clinic/Center, Urgent Care––Yes

Practice location

1110 Pennsylvania Ave
Suite 5
Brooklyn, NY 11207-9003

Phone 646-942-2842

Mailing address

1110 Pennsylvania Ave
Suite 5
Brooklyn, NY 11207-9003

Phone 646-942-2842

Authorized official

Jacqueline Storey
Physician
6469422842

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