Provider Demographics
NPI:1013934025
Name:CITY WIDE HEALTH FACILITY, INC.
Entity Type:Organization
Organization Name:CITY WIDE HEALTH FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:REZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-621-1811
Mailing Address - Street 1:201 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1106
Mailing Address - Country:US
Mailing Address - Phone:718-621-1811
Mailing Address - Fax:718-837-1274
Practice Address - Street 1:201 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1106
Practice Address - Country:US
Practice Address - Phone:718-621-1811
Practice Address - Fax:718-837-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 261QM2500X
NY7001103R282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02279954Medicaid
NYW39471Medicare UPIN