| Blue Green Horizons Office Based Surgery Pllc | |
|
200 Brooklyn Ave Brooklyn NY 11213-1908 | |
| (718) 498-7888 | |
| (718) 604-7890 |
| Full Name | Blue Green Horizons Office Based Surgery Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 200 Brooklyn Ave, Brooklyn, New York |
| Authorized Official Name and Position | Shelby K. Samuel (OWNER) |
| Authorized Official Contact | 7184987888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Green Horizons Office Based Surgery Pllc 200 Brooklyn Ave Brooklyn NY 11213-1908 Ph: (718) 498-7888 | Blue Green Horizons Office Based Surgery Pllc 200 Brooklyn Ave Brooklyn NY 11213-1908 Ph: (718) 498-7888 |
| NPI Number | 1073835641 |
|---|---|
| Provider Enumeration Date | 02/23/2010 |
| Last Update Date | 02/23/2010 |
| Medicare PECOS PAC ID | 4688805104 |
|---|---|
| Medicare Enrollment ID | O20140326002267 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073835641 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 176352 (New York) | Primary |
| Provider Name | Shelby K Samuel |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1114947157 PECOS PAC ID: 2567374184 Enrollment ID: I20031103000392 |
| Provider Name | Zesong Zhang |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1649522392 PECOS PAC ID: 8325292386 Enrollment ID: I20130129000440 |
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