Provider Demographics
NPI:1639551070
Name:WYCKOFF HEIGHTS MEDICAL CENTER
Entity Type:Organization
Organization Name:WYCKOFF HEIGHTS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRY
Authorized Official - Prefix:
Authorized Official - First Name:DUC
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-744-9584
Mailing Address - Street 1:10460 QUEENS BLVD
Mailing Address - Street 2:APT 10P
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10460 QUEENS BLVD
Practice Address - Street 2:APT 10P
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7318
Practice Address - Country:US
Practice Address - Phone:586-744-9584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital