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General NPI Number Information
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NPI Number | 1710201512
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Entity Type | Organization
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Legal Business Name | SUNY DOWNSTATE MEDICAL CENTER
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 450 CLARKSON AVE STE D
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City | BROOKLYN
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State | NY
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Zip | 11203-2012
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Country | US
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Telephone | 718-270-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 42ND ST
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City | BROOKLYN
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State | NY
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Zip | 11219-1406
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Country | US
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Telephone | 718-673-0925
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Fax |
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Authorized Official
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Title or Position | STAFF ASSISTANT
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Name | ANGELIQUE PIETERS
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Credential |
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Telephone | 718-270-3279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | 255067
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License Number State | NY
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