Provider Demographics
NPI:1700551199
Name:UNIVERSITY HOSPITAL OF BROOKLYN SUNY DOWNSTATE HEALTH SCIENCES UNIVERS
Entity Type:Organization
Organization Name:UNIVERSITY HOSPITAL OF BROOKLYN SUNY DOWNSTATE HEALTH SCIENCES UNIVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR ASSOCIATE VP/ DEPUTY CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-826-4943
Mailing Address - Street 1:711 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1507
Mailing Address - Country:US
Mailing Address - Phone:718-826-4901
Mailing Address - Fax:
Practice Address - Street 1:445 LENOX RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2017
Practice Address - Country:US
Practice Address - Phone:718-826-4901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7001037Medicaid