Basic Information
| Provider Information | |||||||||
| NPI: | 1922480607 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WYCKOFF HEIGHTS MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 88 WAVERLY AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112052404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072671416 | ||||||||
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| Practice Location | |||||||||
| Address1: | 374 STOCKHOLM STREET | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189637272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2015 | ||||||||
| LastUpdateDate: | 06/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | COSTE | ||||||||
| AuthorizedOfficialFirstName: | ANOUCHKA | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENT PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4072671416 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | NY | Y | Hospitals | General Acute Care Hospital |
No ID Information.