Provider Demographics
NPI:1528481348
Name:WOMEN'S HEALTH CENTER EXT CLINIC
Entity type:Organization
Organization Name:WOMEN'S HEALTH CENTER EXT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:VUTRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-963-6702
Mailing Address - Street 1:374 STOCKHOLM ST
Mailing Address - Street 2:WYCKOFF HEIGHTS MEDICAL CENTER - FACULTY PRACTICE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4006
Mailing Address - Country:US
Mailing Address - Phone:718-486-4155
Mailing Address - Fax:
Practice Address - Street 1:110 WYCKOFF AVE
Practice Address - Street 2:WOMEN'S HEALTH CENTER EXT CLINIC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-3904
Practice Address - Country:US
Practice Address - Phone:718-963-6485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STOCKHOLM OB/GYN SERVICES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-30
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03299956Medicaid
NY03299956Medicaid