Healthcare Provider Details

I. General information

NPI: 1740366806
Provider Name (Legal Business Name): KINGS COUNTY HOSPITAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21-49-46 STREET
ASTORIA NY
11105
US

IV. Provider business mailing address

21-49-46 STREET
ASTORIA NY
11105
US

V. Phone/Fax

Practice location:
  • Phone: 718-726-3129
  • Fax:
Mailing address:
  • Phone: 718-726-3129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. RAFAEL CALDERON
Title or Position: PA-C
Credential:
Phone: 718-726-3129