Provider Demographics
NPI:1376878173
Name:VETERANS AFFAIRS MEDICAL CENTRE
Entity Type:Organization
Organization Name:VETERANS AFFAIRS MEDICAL CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KORSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-584-9000
Mailing Address - Street 1:3489 FORT INDEPENDENCE ST
Mailing Address - Street 2:APT #5-G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4540
Mailing Address - Country:US
Mailing Address - Phone:917-285-4985
Mailing Address - Fax:
Practice Address - Street 1:3489 FORT INDEPENDENCE ST
Practice Address - Street 2:APT #5-G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4540
Practice Address - Country:US
Practice Address - Phone:917-285-4985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital