Provider Demographics
NPI:1316461387
Name:KINGS MEDICAL FAMILY PRACTICE PC
Entity type:Organization
Organization Name:KINGS MEDICAL FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:OZUZU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-234-4673
Mailing Address - Street 1:4809 AVENUE N STE 273
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3711
Mailing Address - Country:US
Mailing Address - Phone:718-975-2270
Mailing Address - Fax:
Practice Address - Street 1:681 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5698
Practice Address - Country:US
Practice Address - Phone:718-975-2270
Practice Address - Fax:718-975-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty