Provider Demographics
NPI:1801979687
Name:KING COUNTY HOSPITAL CENTER
Entity type:Organization
Organization Name:KING COUNTY HOSPITAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRAUMA COORDINATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:DUPREE
Authorized Official - Last Name:SELAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD FNP
Authorized Official - Phone:718-245-4686
Mailing Address - Street 1:638 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1204
Mailing Address - Country:US
Mailing Address - Phone:718-245-4686
Mailing Address - Fax:718-245-4055
Practice Address - Street 1:368 EAST 57TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-1204
Practice Address - Country:US
Practice Address - Phone:718-763-0574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331680282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02102096Medicaid