Basic Information
| Provider Information | |||||||||
| NPI: | 1790798007 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOODHUL MEDICAL AND MENTAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 760 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189638000 | ||||||||
| FaxNumber: | 7189638753 | ||||||||
| Practice Location | |||||||||
| Address1: | 760 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189638000 | ||||||||
| FaxNumber: | 7189638753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BAHTIYAR | ||||||||
| AuthorizedOfficialFirstName: | GUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | ATTENDING PHYSICIAN-ENDOCRINOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 7189638000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 002487 | NY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 002487 | 01 | NY | LIMITED MEDICAL LICENSE | OTHER |