Basic Information
| Provider Information | |||||||||
| NPI: | 1962777847 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METROPOLITAN HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 CARNATION RD | ||||||||
| Address2: | |||||||||
| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117952802 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 1ST AVE | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100297404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124236262 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2012 | ||||||||
| LastUpdateDate: | 03/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | BOTHWELL | ||||||||
| AuthorizedOfficialFirstName: | MIKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 2032730863 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 015373 | NY | Y | Hospitals | General Acute Care Hospital |
No ID Information.