Provider Demographics
NPI:1730136284
Name:UNIVERSITY PHYSICIANS OF BROOKLYN
Entity Type:Organization
Organization Name:UNIVERSITY PHYSICIANS OF BROOKLYN
Other - Org Name:DOWNSTATE PATHOLOGY GROUP
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 2:4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-2744
Practice Address - Fax:718-270-4567
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
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWLA831Medicare PIN