Organization
STATEN ISLAN UNIVERSITY HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILFREDO GONZALEZ CACAC (MANAGER)
(718) 307-3000
Entity
Organization
Contact information
Practice address
567 E 105TH ST, BROOKLYN, NY 11236-2213
(718) 307-3000
(718) 307-3020
Mailing address
567 E 105TH ST, BROOKLYN, NY 11236-2213
(718) 307-3000
(718) 307-3020
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
—
—
Other
Enumeration date
12/14/2011
Last updated
12/14/2011
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