Provider Demographics
NPI:1689715476
Name:UNIVERSITY PHYSICIANS OF BROOKLYN, INC.
Entity Type:Organization
Organization Name:UNIVERSITY PHYSICIANS OF BROOKLYN, INC.
Other - Org Name:UPB CHILDREN'S MENTAL HEALTH CENTER
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 1:445 LENOX RD
Practice Address - Street 2:SUITE D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2017
Practice Address - Country:US
Practice Address - Phone:718-270-2036
Practice Address - Fax:718-270-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03888864Medicaid
NY03888864Medicaid