Provider Demographics
NPI:1972316404
Name:BROOKLYN MEDICAL PRACTICE PC
Entity type:Organization
Organization Name:BROOKLYN MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NEESHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MOHAMMED-LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-699-7246
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-0030
Mailing Address - Country:US
Mailing Address - Phone:855-699-7246
Mailing Address - Fax:
Practice Address - Street 1:185 KINGSLAND ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1119
Practice Address - Country:US
Practice Address - Phone:855-699-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty