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General NPI Number Information
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NPI Number | 1972110096
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Entity Type | Organization
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Legal Business Name | WYCKOFF HEIGHTS MEDICAL CENTER LABORATORY SERVICES
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 374 STOCKHOLM ST
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City | BROOKLYN
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State | NY
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Zip | 11237-4006
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Country | US
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Telephone | 718-486-4136
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Fax |
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Provider Business Mailing Address
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Address Line | 374 STOCKHOLM ST
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City | BROOKLYN
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State | NY
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Zip | 11237-4006
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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 | CHIEF FINANCIAL OFFICER
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Name | VALI GACHE
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Credential |
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Telephone | 718-240-1795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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