1598949000 NPI number — SUNY DOWNSTATE MEDICAL CENTER

Table of content: (NPI 1598949000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598949000 NPI number — SUNY DOWNSTATE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNY DOWNSTATE MEDICAL CENTER
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:
1598949000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 GRAVESEND NECK RD
Provider Second Line Business Mailing Address:
#2A
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11229-4328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-322-7137
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 CLARKSON AVE.
Provider Second Line Business Practice Location Address:
DEPT. OF MEDICINE, DIV. OF CARDIOLOGY.
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-270-1568
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POLUDASU
Authorized Official First Name:
SHYAM
Authorized Official Middle Name:
SUNDER
Authorized Official Title or Position:
FELLOW IN CARDIOLOGY
Authorized Official Telephone Number:
718-270-1568

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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