Organization
WYCKOFF HEIGHTS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESIREE BULLOCK (CLINICAL SUPERVISOR)
(347) 466-6341
Entity
Organization
Contact information
Practice address
545 CHRISTOPHER AVE, BROOKLYN, NY 11212-7029
(347) 466-6341
Mailing address
545 CHRISTOPHER AVE, BROOKLYN, NY 11212-7029
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RO40749-1
LICENSE NUMBER
NY
Enumeration date
08/02/2016
Last updated
08/02/2016
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