Provider Demographics
NPI:1497828164
Name:WOODHULL MEDICAL AND MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:WOODHULL MEDICAL AND MENTAL HEALTH CENTER
Other - Org Name:WOODHULL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATTENDING ANESTHESIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TSIFRINOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-963-8000
Mailing Address - Street 1:40 OCEANA DR W
Mailing Address - Street 2:APT. 2C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6665
Mailing Address - Country:US
Mailing Address - Phone:718-332-2713
Mailing Address - Fax:718-963-8501
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:SUIT 3A-30
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-8000
Practice Address - Fax:718-963-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221721282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY221721OtherLICENSE