Provider Demographics
NPI:1851772511
Name:WYCKOFF HEIGHTS MEDICAL CENTER
Entity Type:Organization
Organization Name:WYCKOFF HEIGHTS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENCY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-963-7332
Mailing Address - Street 1:43 POWERS ST # 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-3514
Mailing Address - Country:US
Mailing Address - Phone:818-915-5705
Mailing Address - Fax:
Practice Address - Street 1:43 POWERS ST # 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-3514
Practice Address - Country:US
Practice Address - Phone:818-915-5705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004232261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric