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General NPI Number Information
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NPI Number | 1669690152
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Entity Type | Organization
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Legal Business Name | INTERFAITH MEDICAL CENTER
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1275 BEDFORD AVE STE 1
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City | BROOKLYN
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State | NY
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Zip | 11216-2711
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Country | US
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Telephone | 718-613-7401
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Fax |
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Provider Business Mailing Address
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Address Line | 1275 BEDFORD AVE STE 1
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City | BROOKLYN
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State | NY
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Zip | 11216-2711
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Country | US
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Telephone | 718-613-7401
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MR. BERNARD SIMON
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Credential | LCSW-R
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Telephone | 718-613-7419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R058801
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License Number State | NY
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