Provider Demographics
NPI:1619366978
Name:BROOKLYN PLAZA MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:BROOKLYN PLAZA MEDICAL CENTER, INC
Other - Org Name:WHITMAN INGERSOLL FARRAGUT HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAZETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-596-9800
Mailing Address - Street 1:650 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1517
Mailing Address - Country:US
Mailing Address - Phone:718-596-9800
Mailing Address - Fax:718-596-9889
Practice Address - Street 1:297 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2901
Practice Address - Country:US
Practice Address - Phone:718-596-8000
Practice Address - Fax:718-596-8935
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKLYN PLAZA MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001250R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)