1205305331 NPI number — SUNSET PARK HEALTH COUNCIL, INC.

Table of content: (NPI 1205305331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205305331 NPI number — SUNSET PARK HEALTH COUNCIL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNSET PARK HEALTH COUNCIL, INC.
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:
6
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:
1205305331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 55TH ST
Provider Second Line Business Mailing Address:
FHC ADMINISTRATION
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11220-2508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-630-7047
Provider Business Mailing Address Fax Number:
718-630-8873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
514 49TH ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
BROOKYLN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11220-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-431-2693
Provider Business Practice Location Address Fax Number:
718-431-2698
Provider Enumeration Date:
11/19/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
ASTRID
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
718-630-7047

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 037345 . This is a "NYS PHARMACY LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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