Basic Information
Provider Information
NPI: 1730238387
EntityType: 2
ReplacementNPI:  
OrganizationName: CATHOLIC MEDICAL CENTER OF BRROKLYN AND QUEENS
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: SAINT JOHNS HOSPITAL
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 450 W 33RD ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100012603
CountryCode: US
TelephoneNumber: 2123564419
FaxNumber: 2123564434
Practice Location
Address1: 9002 QUEENS BLVD
Address2:  
City: ELMHURST
State: NY
PostalCode: 113734941
CountryCode: US
TelephoneNumber: 7185581000
FaxNumber: 2123564434
Other Information
ProviderEnumerationDate: 01/10/2007
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: YORKE
AuthorizedOfficialFirstName: DOLLYANN
AuthorizedOfficialMiddleName: L
AuthorizedOfficialTitleorPosition: DIRECTOR OF REIMBURSEMENT
AuthorizedOfficialTelephone: 2123564419
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X7003008HNYY HospitalsGeneral Acute Care Hospital 

ID Information
IDTypeStateIssuerDescription
0024412405NY MEDICAID


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