Basic Information
Provider Information
NPI: 1407050800
EntityType: 2
ReplacementNPI:  
OrganizationName: WOODHULL HOSPITAL
LastName:  
FirstName:  
MiddleName:  
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NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 136 HICKS ST
Address2: 3E
City: BROOKLYN
State: NY
PostalCode: 112012366
CountryCode: US
TelephoneNumber:  
FaxNumber: 7176303138
Practice Location
Address1: 760 BROADWAY
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112065317
CountryCode: US
TelephoneNumber: 7189636881
FaxNumber: 7186303138
Other Information
ProviderEnumerationDate: 06/12/2007
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: LLOSA
AuthorizedOfficialFirstName: THALIA
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AuthorizedOfficialTitleorPosition: SOCIAL WORKER
AuthorizedOfficialTelephone: 7189636881
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: LMSW
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X074826NYY HospitalsGeneral Acute Care Hospital 

No ID Information.


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