=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376540344
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHEEPSHEAD BAY WOMEN CC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1616A VOORHIES AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-3914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-616-1268
-----------------------------------------------------
Fax | 718-616-1281
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 27360 MMC OB/GYN FPP
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11202-7360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | VICTORIA FALCONE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-283-8864
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------