Healthcare Provider Details

I. General information

NPI: 1376590828
Provider Name (Legal Business Name): UNIVERSITY PHYSICIANS OF BROOKLYN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE 2ND FLOOR
BROOKLYN NY
11203-2056
US

IV. Provider business mailing address

450 CLARKSON AVE MSC#80
BROOKLYN NY
11203-2056
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1603
  • Fax: 718-270-2667
Mailing address:
  • Phone: 718-613-8481
  • Fax: 718-613-8498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALBERT GUIDICE
Title or Position: ENROLLMENT MANAGER
Credential:
Phone: 718-613-8481