Organization
NYCDOHMH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GRACITA MARCELLUS-COQ (NIC)
(718) 254-8997
Entity
Organization
Contact information
Practice address
295 FLATBUSH AVENUE EXT, BROOKLYN, NY 11201-3001
(718) 254-8997
Mailing address
10 ROSE ST, BROOKLYN, NY 11236-3426
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
467933-1
NY
Other
Enumeration date
10/12/2012
Last updated
10/12/2012
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