Pediatric&Adolescent Medical Care PLLC

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

219864 Issued in NY

Legal business name

PEDIATRIC&ADOLESCENT MEDICAL CARE PLLC

Practice address

450 76TH St
Brooklyn, NY 11209-3204

Phone

(718) 333-5483

Fax

(718) 980-0085

NPI assigned

Oct 24, 2013

Organization subpart

No

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

Authorized official

Name

Emad Ghaly, MD

Title

Ceo

Phone

(718) 333-5483

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1382572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382572800000",
    "number": "1699103879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 76TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112093204",
            "telephone_number": "718-333-5483",
            "fax_number": "718-980-0085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 76TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112093204",
            "telephone_number": "718-333-5483",
            "fax_number": "718-980-0085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC&ADOLESCENT MEDICAL CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-24",
        "last_updated": "2013-10-24",
        "status": "A",
        "authorized_official_last_name": "GHALY",
        "authorized_official_first_name": "EMAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-333-5483",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NY",
            "license": "219864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01928032",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY LIC",
            "identifier": "219864",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Adolescent Medicine Physician in Brooklyn, NY
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.