| | Physician Last Name: | 563 Grand Medical |
| | Physician First Name: | P.C. |
| | Physician Middle Name: | |
| | Address: | 563 Grand Street
Brooklyn, NY 11211 |
| | License Number: | 196275 |
| | License Type: | |
| | Year of Birth: |
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| | Effective Date: | 09/29/2010 |
| | Action Description for DOH Webpage: | Revocation of certificate of incorporation. |
| | Misconduct Description for DOH Webpage: | The corporation admitted guilt to the charge of ordering excessive tests, treatment, or use of treatment facilities not warranted by the condition of a patient. |
| | License Limitations or Conditions for DOH Webpage: | |
| | Board Order: |
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