Provider Demographics
NPI:1821287863
Name:KINGS HIGHWAY DIV HOUSE PHYSICIANS
Entity Type:Organization
Organization Name:KINGS HIGHWAY DIV HOUSE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONA
Authorized Official - Middle Name:
Authorized Official - Last Name:HETSRONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-951-3000
Mailing Address - Street 1:160 WATER ST
Mailing Address - Street 2:20TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4922
Mailing Address - Country:US
Mailing Address - Phone:212-256-3539
Mailing Address - Fax:
Practice Address - Street 1:3201 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2625
Practice Address - Country:US
Practice Address - Phone:718-951-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETH ISRAEL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-16
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW77221Medicare PIN