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General NPI Number Information
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NPI Number | 1316200843
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Entity Type | Organization
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Legal Business Name | SUNNY DOWNSTATE MEDICAL CENTER
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 1190 DEAN ST 1
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City | BROOKLYN
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State | NY
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Zip | 11216-3039
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Country | US
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Telephone | 917-599-6748
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Fax |
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Provider Business Mailing Address
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Address Line | 1190 DEAN ST 1
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City | BROOKLYN
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State | NY
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Zip | 11216-3039
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Country | US
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Telephone | 917-599-6748
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Fax |
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Authorized Official
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Title or Position | PGY-1
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Name | KABELO JOSEPH THUSANG
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Credential |
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Telephone | 917-599-6748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 281PC2000X
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Taxonomy Name | Children's Chronic Disease Hospital
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License Number |
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License Number State |
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