Provider Demographics
NPI:1235464538
Name:SAINT VINCENT CATHOLIC MEDICAL CENTER
Entity Type:Organization
Organization Name:SAINT VINCENT CATHOLIC MEDICAL CENTER
Other - Org Name:BAY RIDGE FAMILY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VP & MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-356-4903
Mailing Address - Street 1:450 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2603
Mailing Address - Country:US
Mailing Address - Phone:212-356-4419
Mailing Address - Fax:212-356-4433
Practice Address - Street 1:9920 FOURTH AVENUE
Practice Address - Street 2:#305
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:718-748-5091
Practice Address - Fax:718-748-5119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002037H261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243229Medicaid
NY00243229Medicaid