Healthcare Provider Details

I. General information

NPI: 1962777847
Provider Name (Legal Business Name): METROPOLITAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7404
US

IV. Provider business mailing address

316 CARNATION RD
WEST ISLIP NY
11795-2802
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number015373
License Number StateNY

VIII. Authorized Official

Name: MR. MIKE BOTHWELL
Title or Position: PHYSICIAN ASSISTANT
Credential:
Phone: 203-273-0863