Provider Demographics
NPI:1518228055
Name:SUNY DOWNSTATE MEDICAL CENTER
Entity Type:Organization
Organization Name:SUNY DOWNSTATE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIA RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DORGAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BADRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-403-1292
Mailing Address - Street 1:10 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-2148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-270-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital