Provider Demographics
NPI:1124166657
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:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-240-5811
Mailing Address - Street 1:ONE BROOKDALE PLAZA
Mailing Address - Street 2:ATTN: CHUCK SALVO
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3198
Mailing Address - Country:US
Mailing Address - Phone:718-240-5811
Mailing Address - Fax:718-240-5805
Practice Address - Street 1:1 BROOKDALE PLZ FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-6281
Practice Address - Fax:718-240-6682
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE BROOKDALE HOSPITAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-05
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243572Medicaid