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WYCKOFF PEDIATRIC CARE CENTER NPI 1972926814


NPI Information

NPI: 1972926814
Provider Name: WYCKOFF PEDIATRIC CARE CENTER
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 33D2054035

Address:
1411 MYRTLE AVE
1411 MYRTLE AVENUE
BROOKLYN, NY
ZIP 11237
Phone: (718) 907-4301
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WYCKOFF PEDIATRIC CARE CENTER is a pediatrics in Brooklyn, NY. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. WYCKOFF PEDIATRIC CARE CENTER NPI is 1972926814. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1411 MYRTLE AVE
1411 MYRTLE AVENUE
BROOKLYN, NY
ZIP 11237-512
Phone: (718) 907-4301
Fax: (718) 919-1309

The provider's authorized official is Vali Gache .
The authorized official title is Chief Financial Officer and has the following contact phone number (718) 240-1795.

The CLIA number assigned to this NPI record is 33D2054035 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/29/2014 and was last updated on 4/2/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
103722025MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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