=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326046467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BROOKLYN HOSPITAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2005
-----------------------------------------------------
Last Update Date | 04/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 DEKALB AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11201-5425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-488-3736
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 DEKALB AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11201-5425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-488-3736
-----------------------------------------------------
Fax | 718-488-3719
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF REVENUE CYCLE
-----------------------------------------------------
Name | NELSON FERREREAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-488-3736
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 7001003H
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------