Healthcare Provider Details

I. General information

NPI: 1265510200
Provider Name (Legal Business Name): WOODHULL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6421 BOOTH ST APT 4C
REGO PARK NY
11374-3028
US

IV. Provider business mailing address

6421 BOOTH ST APT 4C
REGO PARK NY
11374-3028
US

V. Phone/Fax

Practice location:
  • Phone: 917-734-2198
  • Fax:
Mailing address:
  • Phone: 917-734-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number218442
License Number StateNY

VIII. Authorized Official

Name: TADEUSZ WITKOWSKI
Title or Position: ATTENDING
Credential: M.D.
Phone: 718-630-3220