Healthcare Provider Details

I. General information

NPI: 1972545036
Provider Name (Legal Business Name): THE BROOKDALE HOSPITAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKDALE PLZ 12 CHC
BROOKLYN NY
11212-3139
US

IV. Provider business mailing address

80 MARCUS DR PROVIDER ENROLLMENT
MELVILLE NY
11747-4230
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-5145
  • Fax:
Mailing address:
  • Phone: 631-391-7700
  • Fax: 631-454-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

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