Healthcare Provider Details

I. General information

NPI: 1902909302
Provider Name (Legal Business Name): WOODHULL MEDICAL & MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY
BROOKLYN NY
11206-5317
US

IV. Provider business mailing address

760 BROADWAY
BROOKLYN NY
11206-5317
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-8533
  • Fax:
Mailing address:
  • Phone: 718-963-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NW0100X
TaxonomyWomen's Hospital
License Number2371151
License Number StateNY

VIII. Authorized Official

Name: MR. BONALD T PHILLIPS
Title or Position: ATTENDING
Credential: MD
Phone: 718-963-8533