Healthcare Provider Details

I. General information

NPI: 1619366978
Provider Name (Legal Business Name): WHITMAN INGERSOLL FARRAGUT HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 MYRTLE AVE
BROOKLYN NY
11205-2901
US

IV. Provider business mailing address

650 FULTON ST
BROOKLYN NY
11217-1517
US

V. Phone/Fax

Practice location:
  • Phone: 718-596-8000
  • Fax: 718-596-8935
Mailing address:
  • Phone: 718-596-9800
  • Fax: 718-596-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number7001250R
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1619366978
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: SYLVIA RICHARDSON
Title or Position: REVENUE MANGAER
Credential:
Phone: 718-596-9800