Healthcare Provider Details

I. General information

NPI: 1568167187
Provider Name (Legal Business Name): BROOKLYN VROLYK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 COOMBS FARM RD
MORGANTOWN WV
26508-0053
US

IV. Provider business mailing address

2000 COOMBS FARM RD
MORGANTOWN WV
26508-0053
US

V. Phone/Fax

Practice location:
  • Phone: 304-381-2211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: