Provider Demographics
NPI:1013176700
Name:KINGSBROOK JEWISH MEDICAL CENTER
Entity Type:Organization
Organization Name:KINGSBROOK JEWISH MEDICAL CENTER
Other - Org Name:KINGSBROOK JEWISH MEDICAL CENTER PHYSICIAN GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:VP-REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BATHEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-604-5578
Mailing Address - Street 1:585 SCHENECTADY AVE
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1809
Mailing Address - Country:US
Mailing Address - Phone:718-604-5469
Mailing Address - Fax:718-604-5527
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:MANAGED CARE DEPT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1809
Practice Address - Country:US
Practice Address - Phone:718-604-5469
Practice Address - Fax:718-604-5527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGSBROOK JEWISH MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-06
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001033H261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01957033Medicaid
NYW78651Medicare PIN