| | Physician Last Name: | Downstate Medical |
| | Physician First Name: | P.C. |
| | Physician Middle Name: | |
| | Address: | 3062 Brighton 13th Street
Brooklyn, New york 11235 |
| | License Number: | 151983 |
| | License Type: | |
| | Year of Birth: |
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| | Effective Date: | 12/19/2006 |
| | Action Description for DOH Webpage: | Revocation of Certificate of Incorporation. |
| | Misconduct Description for DOH Webpage: | The Corporation was rendered in violation of New York State Business Corporation Law Section 1503(a) and (b) and 1504(a) by virtue of the surrender of the sole shareholder's medical license. |
| | License Limitations or Conditions for DOH Webpage: | |
| | Board Order: |
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