MEDICARE: WYCKOFF HEIGHTS MEDICAL 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
1	282N00000X	General Acute Care Hospital	7001035H	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700886322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYCKOFF HEIGHTS MEDICAL CENTER

Provider Business Mailing Address
First Line	:	374 STOCKHOLM ST
Second Line	:	3RD FLOOR ADMINISTRATION
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4006
Country	:	US
Telephone Number	:	718-963-7152
Fax Number	:	718-963-7719

Provider Business Practice Location Address
First Line	:	374 STOCKHOLM ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4006
Country	:	US
Telephone Number	:	718-963-6485
Fax Number	:	718-963-6793

Authorized Official
Title or Position	:	C.F.O.
Name	:	MR. FRANK VUTRANO
Credential	:
Telephone Number	:	718-963-7152

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	04/25/2016

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