Basic Information
| Provider Information | |||||||||
| NPI: | 1851702815 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KINGSBROOK JEWISH MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1125 BANNER AVE, 7D | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036949444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 585 SCHENECTADY AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112031851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186045000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2014 | ||||||||
| LastUpdateDate: | 05/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | NOEL | ||||||||
| AuthorizedOfficialFirstName: | BEVERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7183636771 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.