Healthcare Provider Details

I. General information

NPI: 1699704155
Provider Name (Legal Business Name): SUNY DOWNSTATE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 LENOX RD
BROOKLYN NY
11203-2017
US

IV. Provider business mailing address

445 LENOX RD
BROOKLYN NY
11203-2017
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1000
  • Fax:
Mailing address:
  • Phone: 718-270-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARILYN VIENTOS-SOTIRIADIS
Title or Position: COO
Credential:
Phone: 718-270-2025