Basic Information
| Provider Information | |||||||||
| NPI: | 1558564088 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOODHULL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 ORCHARD DR | ||||||||
| Address2: | |||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070122114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737770923 | ||||||||
| FaxNumber: | 7186303138 | ||||||||
| Practice Location | |||||||||
| Address1: | WOODHULL HOSPITAL | ||||||||
| Address2: | 760 BROADWAY | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189638951 | ||||||||
| FaxNumber: | 7186303138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEITH | ||||||||
| AuthorizedOfficialFirstName: | RANDALL | ||||||||
| AuthorizedOfficialMiddleName: | BRIAN | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 7189638951 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | R047828-1 | NY | Y | Hospitals | General Acute Care Hospital |
No ID Information.