1093095499 NPI number — WINTHROP INFECTIOUS DISEASE ASSOCIATES UNIV FACULTY PRACTICE CORP

Table of content: MS. NANCY METRA BROOKS L.I.C.S.W. (NPI 1295024511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093095499 NPI number — WINTHROP INFECTIOUS DISEASE ASSOCIATES UNIV FACULTY PRACTICE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINTHROP INFECTIOUS DISEASE ASSOCIATES UNIV FACULTY PRACTICE CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093095499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 STATION PLZ N
Provider Second Line Business Mailing Address:
SUITE 432
Provider Business Mailing Address City Name:
MINEOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11501-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-663-2507
Provider Business Mailing Address Fax Number:
516-663-3234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 STATION PLZ N
Provider Second Line Business Practice Location Address:
SUITE 432
Provider Business Practice Location Address City Name:
MINEOLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11501-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-663-2507
Provider Business Practice Location Address Fax Number:
516-663-3234
Provider Enumeration Date:
08/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CUNHA
Authorized Official First Name:
BURKE
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-663-2507

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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