Provider Demographics
NPI:1225375827
Name:BROOKLYN WOMENS PAVILION LLC
Entity Type:Organization
Organization Name:BROOKLYN WOMENS PAVILION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-222-0123
Mailing Address - Street 1:106-12 LIBERTY AVENUE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1811
Mailing Address - Country:US
Mailing Address - Phone:718-322-1188
Mailing Address - Fax:
Practice Address - Street 1:44 COURT ST
Practice Address - Street 2:SUITE 322
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4405
Practice Address - Country:US
Practice Address - Phone:718-222-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center