Basic Information
| Provider Information | |||||||||
| NPI: | 1750610697 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BROOKDALE UNIVERSITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11924 147TH ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH OZONE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114361528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186594340 | ||||||||
| FaxNumber: | 7186594340 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 BROOKDALE PLZ | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112123139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405000 | ||||||||
| FaxNumber: | 7182405000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2009 | ||||||||
| LastUpdateDate: | 12/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | SPENCE | ||||||||
| AuthorizedOfficialFirstName: | YVONE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7182405000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | NY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1070313819 | 01 | NY | US FAMILY HEALTH PLAN | OTHER |