Healthcare Provider Details

I. General information

NPI: 1215817473
Provider Name (Legal Business Name): INDIVIDUAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2025
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 ATLANTIC AVE
BROOKLYN NY
11213-1122
US

IV. Provider business mailing address

1 SOUTH AVE
GARDEN CITY NY
11530-4299
US

V. Phone/Fax

Practice location:
  • Phone: 718-613-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHEKIRA N BAPTISTE
Title or Position: SOCIAL WORKER STUDENT
Credential:
Phone: 917-575-5370