Provider Demographics
NPI:1972110096
Name:WYCKOFF HEIGHTS MEDICAL CENTER LABORATORY SERVICES
Entity type:Organization
Organization Name:WYCKOFF HEIGHTS MEDICAL CENTER LABORATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:VALI
Authorized Official - Middle Name:
Authorized Official - Last Name:GACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-240-1795
Mailing Address - Street 1:374 STOCKHOLM ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:718-486-4136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYCKOFF HEIGHTS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory