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General NPI Number Information
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NPI Number | 1003063371
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Entity Type | Organization
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Legal Business Name | SUNY DOWNSTATE MEDICAL CENTER UHB
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 450 CLARKSON AVE
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City | BROOKLYN
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State | NY
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Zip | 11203-2056
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Country | US
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Telephone | 718-363-2908
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Fax |
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Provider Business Mailing Address
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Address Line | 450 CLARKSON AVE BOX 59
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City | BROOKLYN
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State | NY
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Zip | 11203-2056
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Country | US
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Telephone | 718-270-8880
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Fax |
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Authorized Official
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Title or Position | CREDENTIALS COORDINATOR
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Name | MS. TANIKA LORICK
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Credential |
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Telephone | 718-270-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 248441
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License Number State | NY
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