Organization Active NPI

South Brooklyn Medical Administrative Services, Inc.

  • Clinic/Center
  • Brooklyn, NY
National Provider Identifier
1114093523
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
7001121R Issued in NY
Legal business name
SOUTH BROOKLYN MEDICAL ADMINISTRATIVE SERVICES, INC.
Practice address
685 3Rd Ave
Brooklyn, NY 11232-1108
Phone
(718) 788-2594
Fax
(718) 788-5848
NPI assigned
Nov 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alexis Bosco
Title
Administrative Director
Phone
(718) 788-2594

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 7001121R NY Primary

Addresses

Primary practice location

685 3Rd Ave
Brooklyn, NY 11232-1108

Mailing address

685 3Rd Ave
Brooklyn, NY 11232-1108
Phone (718) 788-2594

Other identifiers 1

IdentifierTypeStateIssuer
02737286MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200106002218 NY Part B Supplier - Opioid Treatment Program (Otp) 2466528856 Practice locations: Brooklyn, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D1046907South Brooklyn Medical Administrative Services Inc685 Third Avenue, Brooklyn, NY 11232Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Locations

685 3rd Ave
Brooklyn, NY 11232
Phone (718) 788-2594

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763596800000",
    "number": "1114093523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 3RD AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112321108",
            "telephone_number": "718-788-2594",
            "fax_number": "347-529-4829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "685 3RD AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112321108",
            "telephone_number": "718-788-2594",
            "fax_number": "718-788-5848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BROOKLYN MEDICAL ADMINISTRATIVE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A",
        "authorized_official_last_name": "BOSCO",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "718-788-2594"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NY",
            "license": "7001121R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02737286",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.