Provider Demographics
NPI:1992433148
Name:BRUTUS, ROOSEVELT JR
Entity type:Individual
Prefix:
First Name:ROOSEVELT
Middle Name:
Last Name:BRUTUS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 OCEAN AVE APT 6E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7454
Mailing Address - Country:US
Mailing Address - Phone:646-496-7017
Mailing Address - Fax:
Practice Address - Street 1:3457 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5131
Practice Address - Country:US
Practice Address - Phone:718-535-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist