MEDICARE: WOODHULL MEDICAL & MENTAL HEALTH 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	282NW0100X	Women's Hospital	2371151	NY

General Provider Information

NPI Number	:	1902909302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODHULL MEDICAL & MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	760 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-5317
Country	:	US
Telephone Number	:	718-963-8533
Fax Number	:

Provider Business Practice Location Address
First Line	:	760 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-5317
Country	:	US
Telephone Number	:	718-963-8533
Fax Number	:

Authorized Official
Title or Position	:	ATTENDING
Name	:	MR. BONALD T PHILLIPS
Credential	:	MD
Telephone Number	:	718-963-8533

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	08/22/2020

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