# BLUE GREEN HORIZONS OFFICE BASED SURGERY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073835641
- **Authorized official:** SHELBY K. SAMUEL M.D. (OWNER)
- **Authorized official phone:** (718) 498-7888

## Contact information

- **Practice address:** 200 BROOKLYN AVE, BROOKLYN, NY 11213-1908
- **Practice address phone:** (718) 498-7888
- **Practice address fax:** (718) 604-7890
- **Mailing address:** 200 BROOKLYN AVE, BROOKLYN, NY 11213-1908
- **Mailing address phone:** (718) 498-7888
- **Mailing address fax:** (718) 604-7890

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | 176352 | NY | Yes |

## Other

- **Enumeration date:** 02/23/2010
- **Last updated:** 02/23/2010