1225449507 NPI number — STOCKHOLM OB/GYN SERVICES, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225449507 NPI number — STOCKHOLM OB/GYN SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STOCKHOLM OB/GYN SERVICES, PC
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:
1225449507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
374 STOCKHOLM STREET
Provider Second Line Business Mailing Address:
WYCKOFF HEIGHTS MEDICAL CENTER - FACULTY PRACTICE
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-963-7272
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
93-95 WYCKOFF AVE
Provider Second Line Business Practice Location Address:
STOCKHOLM OB/GYN SERVICES, PC
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-486-4155
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
VUTRANO
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
718-963-6702

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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