Provider Demographics
NPI:1528027414
Name:UNIVERSITY HOSPITAL OF BROOKLYN SUNY DOWNSTATE HEALTH SCIENCES UNIVERS
Entity Type:Organization
Organization Name:UNIVERSITY HOSPITAL OF BROOKLYN SUNY DOWNSTATE HEALTH SCIENCES UNIVERS
Other - Org Name:SUNY PARKSIDE DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR ASSOCIATE VP/DEPUTY CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:718-826-4943
Mailing Address - Street 1:710 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1507
Mailing Address - Country:US
Mailing Address - Phone:718-826-4931
Mailing Address - Fax:718-826-5045
Practice Address - Street 1:710 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1507
Practice Address - Country:US
Practice Address - Phone:718-826-4931
Practice Address - Fax:718-826-5045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001037H261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY333544Medicare ID - Type UnspecifiedSUNY-PARKSIDE DIALYSIS CT