Healthcare Provider Details

I. General information

NPI: 1316200843
Provider Name (Legal Business Name): SUNNY DOWNSTATE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 DEAN ST 1
BROOKLYN NY
11216-3039
US

IV. Provider business mailing address

1190 DEAN ST 1
BROOKLYN NY
11216-3039
US

V. Phone/Fax

Practice location:
  • Phone: 917-599-6748
  • Fax:
Mailing address:
  • Phone: 917-599-6748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number
License Number State

VIII. Authorized Official

Name: KABELO JOSEPH THUSANG
Title or Position: PGY-1
Credential:
Phone: 917-599-6748