Basic Information
Provider Information | |||||||||
NPI: | 1841493335 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | WOODHULL HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 233A WYCKOFF ST | ||||||||
Address2: |   | ||||||||
City: | BROOKLYN | ||||||||
State: | NY | ||||||||
PostalCode: | 112172208 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7184516966 | ||||||||
FaxNumber: | 7186303138 | ||||||||
Practice Location | |||||||||
Address1: | WOODHULL HOSPITAL | ||||||||
Address2: | 760 BROADWAY | ||||||||
City: | BROOKLYN | ||||||||
State: | NY | ||||||||
PostalCode: | 11206 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7189638602 | ||||||||
FaxNumber: | 7186303138 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/11/2007 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | TYLER | ||||||||
AuthorizedOfficialFirstName: | SARA | ||||||||
AuthorizedOfficialMiddleName: | CHEEVER | ||||||||
AuthorizedOfficialTitleorPosition: | SOCIAL WORKER | ||||||||
AuthorizedOfficialTelephone: | 7189638602 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | LMSW | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 073660 | NY | Y |   | Hospitals | General Acute Care Hospital |   |
No ID Information.