Provider Demographics
NPI:1700588027
Name:OBH BROOKDALE HOSPITAL MEDICAL CENTER
Entity Type:Organization
Organization Name:OBH BROOKDALE HOSPITAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NILS
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMEGI WENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-410-5318
Mailing Address - Street 1:20704 N 90TH PL UNIT 1026
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-9116
Mailing Address - Country:US
Mailing Address - Phone:513-410-5318
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty