Healthcare Provider Details

I. General information

NPI: 1902820335
Provider Name (Legal Business Name): THE BROOKDALE HOSPITAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKDALE PLZ BLDG CHC 4TH FLOOR
BROOKLYN NY
11212-3139
US

IV. Provider business mailing address

1 BROOKDALE PLAZA ATTN: CHUCK SALVO
BROOKLYN NY
11212-3198
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-5271
  • Fax: 718-485-5858
Mailing address:
  • Phone: 718-240-5811
  • Fax: 718-240-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES SALVO
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 718-240-6374