Provider Demographics
NPI:1104229749
Name:UNIVERSITY PHYSICIANS OF BROOKLYN, INC.
Entity type:Organization
Organization Name:UNIVERSITY PHYSICIANS OF BROOKLYN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIENTOS-SOTIRIADIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-270-2025
Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:MSC#80
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2012
Mailing Address - Country:US
Mailing Address - Phone:718-613-8481
Mailing Address - Fax:718-613-8498
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:MSC#80
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-613-8481
Practice Address - Fax:718-613-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty