Provider Demographics
NPI:1487677472
Name:THE BROOKDALE HOSPITAL MEDICAL CENTER
Entity Type:Organization
Organization Name:THE BROOKDALE HOSPITAL MEDICAL CENTER
Other - Org Name:KINGSBROOK JEWISH MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-604-5000
Mailing Address - Street 1:585 SCHENECTADY AVE.
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-604-5000
Mailing Address - Fax:718-363-6718
Practice Address - Street 1:585 SCHENECTADY AVE.
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-604-5363
Practice Address - Fax:718-363-6718
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE BROOKDALE HOSPITAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336I0012X
NY0020083336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3345863OtherNCPDP
NY00243669Medicaid
3345863OtherNCPDP PROVIDER IDENTIFICATION NUMBER