Healthcare Provider Details

I. General information

NPI: 1770881245
Provider Name (Legal Business Name): SUNY HEALTH SCIENCE CENTER AT BROOKLYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 AMITY ST
BROOKLYN NY
11201-6004
US

IV. Provider business mailing address

97 AMITY ST
BROOKLYN NY
11201-6004
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-1000
  • Fax:
Mailing address:
  • Phone: 718-780-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

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