Basic Information
| Provider Information | |||||||||
| NPI: | 1306230701 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WYCKOFF EMERGENCY MEDICINE SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 374 STOCKHOLM STREET | ||||||||
| Address2: | WYCKOFF EMERGENCY MEDICINE SERVICES, PC | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189637272 | ||||||||
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| Practice Location | |||||||||
| Address1: | 374 STOCKHOLM STREET | ||||||||
| Address2: | WYCKOFF EMERGENCY MEDICINE SERVICES, PC | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189637272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2015 | ||||||||
| LastUpdateDate: | 03/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | IRIZARRY | ||||||||
| AuthorizedOfficialFirstName: | LISANDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN OF EMERGENCY DEPT | ||||||||
| AuthorizedOfficialTelephone: | 7189637272 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WYCKOFF EMERGENCY MEDICINE SERVICES, PC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.