Provider Demographics
NPI:1962451195
Name:BROOKDALE HOSPITAL MEDICAL CENTER
Entity Type:Organization
Organization Name:BROOKDALE HOSPITAL MEDICAL CENTER
Other - Org Name:BROOKDALE EMERGENCY PHYSICIANS ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-240-5811
Mailing Address - Street 1:10101 AVE D
Mailing Address - Street 2:ATTN: DOLLYANN YORKE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1902
Mailing Address - Country:US
Mailing Address - Phone:718-240-8534
Mailing Address - Fax:718-240-6492
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:BROOKDALE UNIVERSITY HOSPITAL & MEDICAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5773
Practice Address - Fax:718-240-5133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE HOSPITAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-06
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01502267Medicaid
NY01502267Medicaid