Provider Demographics
NPI:1306230701
Name:WYCKOFF EMERGENCY MEDICINE SERVICES, PC
Entity Type:Organization
Organization Name:WYCKOFF EMERGENCY MEDICINE SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF EMERGENCY DEPT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-963-7272
Mailing Address - Street 1:374 STOCKHOLM STREET
Mailing Address - Street 2:WYCKOFF EMERGENCY MEDICINE SERVICES, PC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237
Mailing Address - Country:US
Mailing Address - Phone:718-963-7272
Mailing Address - Fax:
Practice Address - Street 1:374 STOCKHOLM STREET
Practice Address - Street 2:WYCKOFF EMERGENCY MEDICINE SERVICES, PC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237
Practice Address - Country:US
Practice Address - Phone:718-963-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYCKOFF EMERGENCY MEDICINE SERVICES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty