Basic Information
| Provider Information | |||||||||
| NPI: | 1871965855 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BROOKVIEW MEDICAL ASSOCIATES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4055 VALLEY VIEW LN STE 200 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752445068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727153800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 80 ORVILLE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | BOHEMIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117162505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727153800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2015 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | AISNER | ||||||||
| AuthorizedOfficialFirstName: | ANITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ORGANIZER | ||||||||
| AuthorizedOfficialTelephone: | 9727153800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator | 363L00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 208D00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.