Basic Information
| Provider Information | |||||||||
| NPI: | 1679951214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAILE | ||||||||
| FirstName: | WORKU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8900 VAN WYCK EXPRESSW | ||||||||
| Address2: | JAMAICA HOSPITAL MEDICAL CENTER | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182067708 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8900 VAN WYCK EXPRESSW | ||||||||
| Address2: | JAMAICA HOSPITAL MEDICAL CENTER | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182067708 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2015 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2018023716 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01083171A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2018023716 | MO | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 01083171A | IN | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.