Provider Demographics
NPI:1477766657
Name:MIDWOOD MEDICAL P.C.
Entity Type:Organization
Organization Name:MIDWOOD MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-336-6667
Mailing Address - Street 1:2222 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3338
Mailing Address - Country:US
Mailing Address - Phone:718-336-6667
Mailing Address - Fax:
Practice Address - Street 1:2222 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3338
Practice Address - Country:US
Practice Address - Phone:718-336-6667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02363468Medicaid
NY02363468Medicaid