1558564088 NPI number — WOODHULL HOSPITAL

Table of content: JEFFREY PAUL CLARK M.A. (NPI 1003979600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558564088 NPI number — WOODHULL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODHULL HOSPITAL
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:
1558564088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 ORCHARD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07012-2114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-777-0923
Provider Business Mailing Address Fax Number:
718-630-3138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WOODHULL HOSPITAL
Provider Second Line Business Practice Location Address:
760 BROADWAY
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-963-8951
Provider Business Practice Location Address Fax Number:
718-630-3138
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEITH
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
BRIAN
Authorized Official Title or Position:
SENIOR SOCIAL WORKER
Authorized Official Telephone Number:
718-963-8951

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  R047828-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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