Provider Demographics
NPI:1174157887
Name:BRAIN INJURY MEDICINE ASSOCIATES PLLC
Entity type:Organization
Organization Name:BRAIN INJURY MEDICINE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLZAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-454-2222
Mailing Address - Street 1:116 SANDFORD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2987
Mailing Address - Country:US
Mailing Address - Phone:718-454-2222
Mailing Address - Fax:718-264-0257
Practice Address - Street 1:9131 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5555
Practice Address - Country:US
Practice Address - Phone:718-454-2222
Practice Address - Fax:718-264-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury MedicineGroup - Multi-Specialty