Healthcare Provider Details

I. General information

NPI: 1639551070
Provider Name (Legal Business Name): WYCKOFF HEIGHTS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10460 QUEENS BLVD APT 10P
FOREST HILLS NY
11375-7318
US

IV. Provider business mailing address

10460 QUEENS BLVD APT 10P
FOREST HILLS NY
11375-7318
US

V. Phone/Fax

Practice location:
  • Phone: 586-744-9584
  • 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: DUC VAN NGUYEN
Title or Position: PODIATRY
Credential:
Phone: 586-744-9584