1750466256 NPI number — WOODHULL MEDICAL & MENTAL HEALTH CENTER

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 1750466256 NPI number — WOODHULL MEDICAL & MENTAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODHULL MEDICAL & MENTAL HEALTH 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:
1750466256
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:
34 CLEVELAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN HEAD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11545-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-671-2024
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 BROADWAY
Provider Second Line Business Practice Location Address:
WOODHULL MEDICAL AND MENTAL HEALTH CTR 3A-30
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11206-5317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-963-8496
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DHABUWALA
Authorized Official First Name:
HANSA
Authorized Official Middle Name:
ASHOK
Authorized Official Title or Position:
ATTENDING ANESTHESIOLOGIST
Authorized Official Telephone Number:
718-963-8496

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  149329 , 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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