Provider Demographics
NPI:1487724712
Name:THE BROOKDALE HOSPITAL MEDICAL CENTER
Entity type:Organization
Organization Name:THE BROOKDALE HOSPITAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-240-6374
Mailing Address - Street 1:10101 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1902
Mailing Address - Country:US
Mailing Address - Phone:718-240-5741
Mailing Address - Fax:
Practice Address - Street 1:1545 ATLANTIC AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213
Practice Address - Country:US
Practice Address - Phone:716-222-7692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001046H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00734336Medicaid
NY7001002HMedicaid
NY00734336Medicaid
NY3303973OtherHIP
NY33S397OtherMEDICARE EXEMPT UNIT
NY000412345683OtherHEALTHFIRST
NY000412345683OtherHEALTHFIRST