Basic Information
| Provider Information | |||||||||
| NPI: | 1093047821 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTERFAITH MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1545 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112131122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186134000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1545 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112131122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186134000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2010 | ||||||||
| LastUpdateDate: | 05/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | SHEPPARD-DURANT | ||||||||
| AuthorizedOfficialFirstName: | GERMAINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | FAMILY NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 3473855191 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | FNP-BC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | F335375 | NY | Y | Hospitals | General Acute Care Hospital |
No ID Information.