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General NPI Number Information
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NPI Number | 1780973206
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Entity Type | Organization
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Legal Business Name | CONEY ISLAND HOSPITAL
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 2040 FOREST AVENUE
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City | STATEN ISLAND
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State | NY
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Zip | 10303
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Country | US
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Telephone | 718-761-2060
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Fax |
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Provider Business Mailing Address
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Address Line | 2040 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10303-1737
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Country | US
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Telephone | 718-761-2060
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | MR. MICHAEL KANTAR
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Credential | MS, RD
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Telephone | 718-761-2060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 1015604
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License Number State | NY
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