Healthcare Provider Details

I. General information

NPI: 1801031919
Provider Name (Legal Business Name): KINGSBROOK JEWISH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1809
US

IV. Provider business mailing address

158 W 27TH ST 11TH FLOOR SOUTH
NEW YORK NY
10001-6216
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5000
  • Fax:
Mailing address:
  • Phone: 212-563-2497
  • Fax: 212-563-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number007809
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number202704
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number184245
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number167289
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number197828
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number220673
License Number StateNY

VIII. Authorized Official

Name: MR. KIRAN N BATHEJA
Title or Position: ASSISTANT VP
Credential:
Phone: 718-604-5578