Provider Demographics
NPI:1740411891
Name:NEW YORK METHODIST HOSPITAL
Entity Type:Organization
Organization Name:NEW YORK METHODIST HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ADINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELITA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:718-351-3692
Mailing Address - Street 1:5 SALZBURG CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2941
Mailing Address - Country:US
Mailing Address - Phone:718-351-3692
Mailing Address - Fax:
Practice Address - Street 1:506 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3609
Practice Address - Country:US
Practice Address - Phone:718-351-3692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013409282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital