Organization
PEDIATRIC&ADOLESCENT MEDICAL CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMAD GHALY MD (CEO)
(718) 333-5483
Entity
Organization
Contact information
Practice address
450 76TH ST, BROOKLYN, NY 11209-3204
(718) 333-5483
(718) 980-0085
Mailing address
450 76TH ST, BROOKLYN, NY 11209-3204
(718) 333-5483
(718) 980-0085
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
219864
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01928032
—
NY
01
—
219864
NY LIC
NY
Enumeration date
10/24/2013
Last updated
10/24/2013
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