Organization
AVENUE U PEDIATRICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALBERT BASSOUL MD (OWNER)
(718) 376-4636
Entity
Organization
Contact information
Practice address
2149 E 5TH ST, BROOKLYN, NY 11223-4038
(718) 376-4636
(718) 376-4635
Mailing address
2149 E 5TH ST, BROOKLYN, NY 11223-4038
(718) 376-4636
(718) 376-4635
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
223690
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2255310
—
NY
Enumeration date
10/06/2016
Last updated
10/06/2016
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