Provider Demographics
NPI:1104127984
Name:BROOKDALE HOSPITAL
Entity type:Organization
Organization Name:BROOKDALE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHISICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMENOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-277-9084
Mailing Address - Street 1:2258 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3328
Mailing Address - Country:US
Mailing Address - Phone:347-277-9084
Mailing Address - Fax:
Practice Address - Street 1:2258 84TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3328
Practice Address - Country:US
Practice Address - Phone:347-277-9084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2592091261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2592091OtherSTATE OF NEW YORK