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General NPI Number Information
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NPI Number | 1184844870
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Entity Type | Organization
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Legal Business Name | SOUTH ELLIOT SOUTH PORTLAND MEDICAL COMPREHENSIVE MEDICAL CENTER
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 739 FULTON ST
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City | BROOKLYN
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State | NY
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Zip | 11217-1560
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Country | US
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Telephone | 718-858-5088
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Fax | 718-858-5278
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Provider Business Mailing Address
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Address Line | GPO 27007
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City | NEW YORK
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State | NY
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Zip | 10087-7007
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Country | US
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Telephone | 718-858-5088
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Fax | 718-858-5278
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CAMILLE PHILIPPE
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Credential | MD, PC
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Telephone | 718-858-5088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 147143
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License Number State | NY
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