Provider Demographics
NPI:1477851707
Name:SUNY HEALTH SCIENCE CENTER AT BROOKLYN
Entity Type:Organization
Organization Name:SUNY HEALTH SCIENCE CENTER AT BROOKLYN
Other - Org Name:SUNY DMC@ LICH -OTOLARYNGOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIENTOS - SOTIRIADIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-270-2025
Mailing Address - Street 1:134 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5502
Mailing Address - Country:US
Mailing Address - Phone:718-780-1498
Mailing Address - Fax:
Practice Address - Street 1:134 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5502
Practice Address - Country:US
Practice Address - Phone:718-780-1498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty