Basic Information
| Provider Information | |||||||||
| NPI: | 1922434216 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNY DOWNSTATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 910 SAINT JOHNS PL | ||||||||
| Address2: | APT 2 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112164306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314086128 | ||||||||
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| Practice Location | |||||||||
| Address1: | 450 CLARKSON AVE | ||||||||
| Address2: | BOX 49 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182702078 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2013 | ||||||||
| LastUpdateDate: | 09/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | SCHAEFFER | ||||||||
| AuthorizedOfficialFirstName: | HENRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7182702078 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.