Provider Demographics
NPI:1194886416
Name:FAMILY MEDICAL GROUP OF NOSTRAND AVENUE
Entity type:Organization
Organization Name:FAMILY MEDICAL GROUP OF NOSTRAND AVENUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-283-8773
Mailing Address - Street 1:GPO BOX 27848
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7848
Mailing Address - Country:US
Mailing Address - Phone:718-283-8773
Mailing Address - Fax:718-283-8796
Practice Address - Street 1:2306 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3840
Practice Address - Country:US
Practice Address - Phone:718-283-8773
Practice Address - Fax:718-283-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWDW381Medicare ID - Type Unspecified