Provider Demographics
NPI:1619171311
Name:WOODHULL MEDICAL CENTER
Entity Type:Organization
Organization Name:WOODHULL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR SOCIAL WORKER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:CARMELLE
Authorized Official - Last Name:MOISE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:718-963-5915
Mailing Address - Street 1:11591 229TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WOODHULL MEDICAL CENTER
Practice Address - Street 2:760 BROADWAY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-5915
Practice Address - Fax:718-630-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064200-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY300608Medicare ID - Type Unspecified