NPIMap

Organization Active NPI

Wyckoff Doctors

  • Clinic/Center
  • Brooklyn, NY
National Provider Identifier
1790164317
Registry record updated Aug 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
WYCKOFF DOCTORS
Practice address
1610 Dekalb Avenue
Wyckoff Doctors
Brooklyn, NY 11237-3906
Phone
(718) 963-7676
Fax
(718) 963-6667
NPI assigned
May 28, 2015
Organization subpart
Yes
Parent organization
WYCKOFF PROFESSIONAL MEDICAL SERVICES PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 20, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Frank Vutrano
Title
Chief Financial Officer
Phone
(718) 963-6702

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1610 Dekalb Avenue
Wyckoff Doctors
Brooklyn, NY 11237-3906

Mailing address

374 Stockholm Street
Wyckoff Professional Medical Services, PC - Faculty Pra
Brooklyn, NY 11237-4006
Phone (718) 963-7676

Other identifiers 1

IdentifierTypeStateIssuer
03722025MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Wyckoff Orthopaedic Ser4 organizations share this tax ID, including this one
Part of
Wyckoff Orthopaedic Ser

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471651200000",
    "number": "1790164317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "374 STOCKHOLM STREET",
            "address_2": "WYCKOFF PROFESSIONAL MEDICAL SERVICES, PC - FACULTY PRA",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374006",
            "telephone_number": "718-963-7676",
            "fax_number": "718-963-6667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 DEKALB AVENUE",
            "address_2": "WYCKOFF DOCTORS",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112373906",
            "telephone_number": "718-963-7676",
            "fax_number": "718-963-6667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYCKOFF DOCTORS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WYCKOFF PROFESSIONAL MEDICAL SERVICES PC",
        "enumeration_date": "2015-05-28",
        "last_updated": "2016-08-20",
        "status": "A",
        "authorized_official_last_name": "VUTRANO",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "718-963-6702",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03722025",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.