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General NPI Number Information
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NPI Number | 1922140318
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Entity Type | Organization
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Legal Business Name | BROOKDALE HOSPITAL
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 23 BEACHVIEW AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10306-5106
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Country | US
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Telephone | 718-240-5495
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Fax |
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Provider Business Mailing Address
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Address Line | 23 BEACHVIEW AVENUE
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City | STATEN ISLAND
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State | NY
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Zip | 10306
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Country | US
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Telephone | 718-240-5000
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Fax |
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Authorized Official
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Title or Position | PA SURGERY
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Name | MRS. YELENA AZAROVA
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Credential | PAC
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Telephone | 718-240-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 007888
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License Number State | NY
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