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General NPI Number Information
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NPI Number | 1225375827
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Entity Type | Organization
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Legal Business Name | BROOKLYN WOMENS PAVILION LLC
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 44 COURT ST SUITE 322
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City | BROOKLYN
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State | NY
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Zip | 11201-4405
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Country | US
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Telephone | 718-222-0123
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Fax |
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Provider Business Mailing Address
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Address Line | 106-12 LIBERTY AVENUE
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City | OZONE PARK
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State | NY
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Zip | 11417-1811
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Country | US
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Telephone | 718-322-1188
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | M JOSEPH
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Credential |
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Telephone | 718-222-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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