Provider Demographics
NPI:1558308411
Name:WYCKOFF MEDICAL SERVICES, P C
Entity Type:Organization
Organization Name:WYCKOFF MEDICAL SERVICES, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHAL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:REMINICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-963-6485
Mailing Address - Street 1:374 STOCKHOLM ST
Mailing Address - Street 2:FACULTY PRACTICE DEPT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4006
Mailing Address - Country:US
Mailing Address - Phone:718-963-6485
Mailing Address - Fax:718-963-6793
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:718-963-6485
Practice Address - Fax:718-963-6793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03373053Medicaid
NYW30641Medicare PIN