Provider Demographics
NPI:1659328193
Name:UNIVERSITY PHYSICIANS OF BROOKLYN, INC.
Entity Type:Organization
Organization Name:UNIVERSITY PHYSICIANS OF BROOKLYN, INC.
Other - Org Name:DOWNSTATE DERMATOLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-613-8481
Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:MSC#80
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2056
Mailing Address - Country:US
Mailing Address - Phone:718-613-8481
Mailing Address - Fax:718-613-8498
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-1230
Practice Address - Fax:718-270-2794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWCF711Medicare PIN