Individual
EFE E EDHOMERIEGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
760 BROADWAY DEPARTMENT OF PSYCHIATRY, WOODHULL MEDICAL & MENTAL HEALTH CENTER, BROOKLYN, NY 11206
(718) 963-8000
(718) 630-3304
Mailing address
760 BROADWAY DEPARTMENT OF MANAGED CARE ROOM 2B230, WOODHULL MEDICAL & MENTAL HEALTH CENTER, BROOKLYN, NY 11206
(718) 963-8000
(718) 630-3304
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
190921
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7615302
—
NJ
Enumeration date
02/02/2006
Last updated
09/08/2016
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