Organization · NPI-2

1120 Brighton Medical Group

Clinical Medical Laboratory · Brooklyn, NY

NPI number1790804227
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1790804227
Entity type
Organization (NPI-2)
Legal business name
1120 Brighton Medical Group
Organization subpart
No
Enumeration date
Mar 28, 2007
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
291U00000X Clinical Medical Laboratory33D0921605NYYes

Other names

  • Brighton Medical Group Physician Lab (Doing Business As)

Practice location

1120 Brighton Beach Ave
Ste 1x
Brooklyn, NY 11235

Phone 718-368-3179 · Fax 718-368-3179

Mailing address

1120 Brighton Beach Ave
Ste #1x
Brooklyn, NY 11235

Phone 718-368-3179 · Fax 718-368-3179

Authorized official

Leon Abramouich Nitkin
Partner
7183683179

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