Basic Information
| Provider Information | |||||||||
| NPI: | 1538321799 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNY DOWNSTATE MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | UNIVERSITY HOSPITAL OF BROOKLYN | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 LENOX RD | ||||||||
| Address2: | BOX 1199 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182701000 | ||||||||
| FaxNumber: | 7182702917 | ||||||||
| Practice Location | |||||||||
| Address1: | 445 LENOX RD | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182701000 | ||||||||
| FaxNumber: | 7182702917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 06/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | OKPALA | ||||||||
| AuthorizedOfficialFirstName: | LOCQUESSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | FAMILY NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 7182704362 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | F3336521 | NY | Y | Hospitals | General Acute Care Hospital | Rural |
No ID Information.