Organization
TBHC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VASANTHA KONDAMUDI MD (CHAIRMAN & PROGRAM DIRECTOR OF FM)
(718) 250-8444
Entity
Organization
Contact information
Practice address
121 DEKALB AVE, BROOKLYN, NY 11201-5425
(718) 250-8444
(718) 250-6599
Mailing address
121 DEKALB AVE, BROOKLYN, NY 11201-5425
(718) 250-8444
(718) 250-6599
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
253900
NY
282N00000X
General Acute Care Hospital
253900
NY
Other
Enumeration date
08/21/2009
Last updated
08/21/2009
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