Provider Demographics
NPI:1215030697
Name:NEW YORK COMMUNITY HOSPITAL OF BROOKLYN INC
Entity Type:Organization
Organization Name:NEW YORK COMMUNITY HOSPITAL OF BROOKLYN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:DERDIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-284-8237
Mailing Address - Street 1:2525 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1705
Mailing Address - Country:US
Mailing Address - Phone:518-299-1667
Mailing Address - Fax:718-692-5309
Practice Address - Street 1:2525 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1705
Practice Address - Country:US
Practice Address - Phone:518-299-1667
Practice Address - Fax:718-692-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000076OtherEBCBS
NY00243696Medicaid
NY00243696Medicaid