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General NPI Number Information
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NPI Number | 1255686184
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Entity Type | Organization
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Legal Business Name | INTERFAITH MEDICAL CENTER
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 1545 ATLANTIC AVE
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City | BROOKLYN
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State | NY
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Zip | 11213-1122
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Country | US
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Telephone | 718-613-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 5 JONES ST APT 3
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City | NEW YORK
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State | NY
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Zip | 10014-5640
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Country | US
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Telephone | 917-520-0015
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGY INTERN
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Name | JENNIFER FLANZ
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Credential | M.A.
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Telephone | 917-520-0015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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