Healthcare Provider Details

I. General information

NPI: 1700588027
Provider Name (Legal Business Name): OBH BROOKDALE HOSPITAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKDALE PLZ
BROOKLYN NY
11212-3139
US

IV. Provider business mailing address

20704 N 90TH PL UNIT 1026
SCOTTSDALE AZ
85255-9116
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-5000
  • Fax:
Mailing address:
  • Phone: 513-410-5318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NILS SUMEGI WENT
Title or Position: RESIDENT PHYSICIAN
Credential: MD
Phone: 513-410-5318