Healthcare Provider Details

I. General information

NPI: 1013934025
Provider Name (Legal Business Name): CITY WIDE HEALTH FACILITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 KINGS HWY
BROOKLYN NY
11223-1106
US

IV. Provider business mailing address

201 KINGS HWY
BROOKLYN NY
11223-1106
US

V. Phone/Fax

Practice location:
  • Phone: 718-621-1811
  • Fax: 718-837-1274
Mailing address:
  • Phone: 718-621-1811
  • Fax: 718-837-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number7001103R
License Number StateNY

VIII. Authorized Official

Name: MR. LARRY REZNIK
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-621-1811