Provider Demographics
NPI:1023229416
Name:B & L HEALTH INC
Entity type:Organization
Organization Name:B & L HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMUNOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-434-2100
Mailing Address - Street 1:1100 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2344
Mailing Address - Country:US
Mailing Address - Phone:718-434-2100
Mailing Address - Fax:929-210-8227
Practice Address - Street 1:1655 E 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1101
Practice Address - Country:US
Practice Address - Phone:718-339-3100
Practice Address - Fax:718-339-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003245R261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01643654Medicaid
=========OtherEIN