Healthcare Provider Details

I. General information

NPI: 1528481348
Provider Name (Legal Business Name): WOMEN'S HEALTH CENTER EXT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WYCKOFF AVE WOMEN'S HEALTH CENTER EXT CLINIC
BROOKLYN NY
11237-3904
US

IV. Provider business mailing address

374 STOCKHOLM ST WYCKOFF HEIGHTS MEDICAL CENTER - FACULTY PRACTICE
BROOKLYN NY
11237-4006
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-6485
  • Fax:
Mailing address:
  • Phone: 718-486-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRANK VUTRANO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 718-963-6702