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NPI Code Detail

MEDICARE: KINGSBORO PSYCHIATRIC CENTER

MEDICARE: KINGSBORO PSYCHIATRIC CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1283Q00000XPsychiatric Hospital232004NY

General Provider Information

NPI Number : 1184704736
Entity Type Code : Organization
Provider Name (Legal Business Name) : KINGSBORO PSYCHIATRIC CENTER
Provider Business Mailing Address
First Line : 215 W POPLAR ST
Second Line :
City : FLORAL PARK
State : NY
Zip : 11001-3311
Country : US
Telephone Number : 718-344-9126
Fax Number :
Provider Business Practice Location Address
First Line : 681 CLARKSON AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2125
Country : US
Telephone Number : 718-221-7161
Fax Number :
Authorized Official
Title or Position : PSYCHIATRIST
Name : DR. MARIO GUSTAVE
Credential : M.D.
Telephone Number : 718-221-7161
Provider Enumeration Date : 10/17/2006
Last Update Date : 08/22/2020

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Directions to “KINGSBORO PSYCHIATRIC CENTER ” Practice Location

Language Start Address Practice Location
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