Provider Demographics
NPI:1336113398
Name:BROOKLYN PLAZA MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BROOKLYN PLAZA MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:ONORATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-596-9800
Mailing Address - Street 1:650 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1517
Mailing Address - Country:US
Mailing Address - Phone:718-596-9800
Mailing Address - Fax:718-596-9889
Practice Address - Street 1:650 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1517
Practice Address - Country:US
Practice Address - Phone:718-596-9800
Practice Address - Fax:718-596-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001250R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000224501OtherAMERICHOICE
27556010OtherHEALTH PLUS CHILD HEALTH
0120218401OtherAMERICHOICE
40426028484OtherFIDELIS
000023004OtherAMERICHOICE
116710101OtherHEALTH PLUS CHILD HEALTH
251330401OtherHEALTH PLUS CHILD HEALTH
275780101OtherHEALTH PLUS CHILD HEALTH
5999757OtherGHI
000195901OtherAMERICHOICE
010007902OtherAMERICHOICE
010223901OtherAMERICHOICE
204590101OtherHEALTH PLUS CHILD HEALTH
40426029577OtherFIDELIS
40426029652OtherFIDELIS
40426058486OtherFIDELIS
NY00357451Medicaid
2361244OtherAETNA
NY00357451Medicaid
000195901OtherAMERICHOICE