Wyckoff Pediatric Care Center

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

WYCKOFF PEDIATRIC CARE CENTER

Practice address

1411 Myrtle Ave
1411 Myrtle Avenue
Brooklyn, NY 11237-4512

Phone

(718) 907-4301

Fax

(718) 919-1309

NPI assigned

Jan 29, 2014

Reactivated

Jun 29, 2015

Last updated

Apr 2, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

WYCKOFF PROFESSIONAL MEDICAL SERVICES PCAs reported in NPPES

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

Authorized official

Name

Vali Gache

Title

Chief Financial Officer

Phone

(718) 240-1795

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

• Wyckoff Doctors

  • Clinic/Center
  • Brooklyn, NY
  • NPI 1790164317
  NPD tax ID
• Wyckoff Pediatric Care Center

  • Clinic/Center
  • Brooklyn, NY
  • NPI 1770962391
  NPD tax ID
• Wyckoff Professional Medical Services PC

  • Clinic/Center
  • Brooklyn, NY
  • NPI 1205201837
  NPD tax ID

Locations

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.

• Wyckoff Professional Medical Services, PC

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1659710796
  NPPES parent name

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

{
    "created_epoch": "1390953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554163200000",
    "number": "1972926814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 MYRTLE AVE",
            "address_2": "WYCKOFF PEDIATRIC CARE CENTER",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374512",
            "telephone_number": "718-907-4301",
            "fax_number": "718-919-1309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 MYRTLE AVE",
            "address_2": "1411 MYRTLE AVENUE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374512",
            "telephone_number": "718-907-4301",
            "fax_number": "718-919-1309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYCKOFF PEDIATRIC CARE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WYCKOFF PROFESSIONAL MEDICAL SERVICES PC",
        "enumeration_date": "2014-01-29",
        "last_updated": "2019-04-02",
        "deactivation_date": "2015-06-29",
        "reactivation_date": "2015-06-29",
        "status": "A",
        "authorized_official_last_name": "GACHE",
        "authorized_official_first_name": "VALI",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "718-240-1795"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03722025",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wyckoff Hospital
• Wyckoff Imaging Services PC
• Wyckoff Medical Associates, PC
• Wyckoff Medical Services, P C
• Wyckoff Pediatric Care Center
• Wyckoff Pharmacy Inc
• Wyckoff Professional Medical Services PC
• Wyckoff Professional Medical Services, PC
• Wyckoff Specialty Script Corp (The Lobby Pharmacy)
• Wyhomo LLC

• Pediatrics Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.