Provider Demographics
NPI:1396728986
Name:BROOKDALE PLAZA NEPHROLOGY ASSOC. PC
Entity type:Organization
Organization Name:BROOKDALE PLAZA NEPHROLOGY ASSOC. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHYAN-YIH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-240-5615
Mailing Address - Street 1:1 BROOKDALE PLZ
Mailing Address - Street 2:ROOM 169CHC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3139
Mailing Address - Country:US
Mailing Address - Phone:718-240-5615
Mailing Address - Fax:718-485-4064
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:ROOM 169CHC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5615
Practice Address - Fax:718-485-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0011077OtherGHI
NY00429410Medicaid
NY0087129OtherAETNA US HEALTHCARE
NYW00561Medicare ID - Type Unspecified