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General NPI Number Information
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NPI Number | 1528282464
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Entity Type | Organization
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Legal Business Name | WOODHULL HOSPITAL
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 760 BROADWAY
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City | BROOKLYN
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State | NY
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Zip | 11206-5317
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Country | US
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Telephone | 347-219-0597
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Fax |
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Provider Business Mailing Address
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Address Line | 16515 14TH RD
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City | WHITESTONE
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State | NY
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Zip | 11357-2903
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MARIANNA TORRE
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Credential |
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Telephone | 347-219-0597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 011567
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License Number State | NY
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