=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265510200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOODHULL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 10/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6421 BOOTH ST APT 4C
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-3028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-734-2198
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6421 BOOTH ST APT 4C
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-3028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-734-2198
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ATTENDING
-----------------------------------------------------
Name | TADEUSZ WITKOWSKI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-630-3220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 218442
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------