| Details | Last Recertification Date | Update | Recertification | 8/22/2023 2:28:40 PM | 8/29/2024 10:18:21 AM | 8/29/2024 10:18 AM |
| Details | Last Recertification Date | Update | Recertification | 8/30/2022 12:38:53 PM | 8/22/2023 2:28:40 PM | 8/22/2023 2:28 PM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2021 3:40:33 PM | 8/30/2022 12:38:53 PM | 8/30/2022 12:38 PM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2020 4:45:05 PM | 9/2/2021 3:40:33 PM | 9/2/2021 3:40 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Minlionica, Kathleen
Director of Pharmacy
The Brooklyn Hospital Center
7182508255 | Minlionica, Kathleen
Director of Pharmacy, Per diem
The Brooklyn Hospital Center
7182508220 | 10/14/2020 4:18 PM |
| Addresses | Billing Address | Insert | Change Request | | The Brooklyn Hospital Center
121 DeKalb Avenue
Brooklyn, NY 11201 | 10/13/2020 9:34 AM |
| Addresses | Shipping Address | Insert | Change Request | | The Brooklyn Hospital Center
121 DeKalb Avenue
Brooklyn, NY 11201 | 10/13/2020 9:34 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1326046467 | 9/2/2020 4:45 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | NY | 9/2/2020 4:45 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1326046467 ( ) | | 9/2/2020 4:45 PM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2019 4:26:41 PM | 9/2/2020 4:45:05 PM | 9/2/2020 4:45 PM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2018 4:02:47 PM | 8/28/2019 4:26:41 PM | 8/28/2019 4:26 PM |
| Details | Last Recertification Date | Update | Recertification | 11/10/2017 10:07:58 AM | 8/23/2018 4:02:47 PM | 8/23/2018 4:02 PM |
| Contacts | Authorizing Official | Update | Change Request | Semenza, Patrick
VP and Chief Financial Officer
The Brooklyn Hospital Center
7184883715 | Minarcik, Donald P.
VP Revenue Enhancement
The Brooklyn Hospital Center
7184883775 | 1/3/2018 7:49 AM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2016 12:00:00 AM | 11/10/2017 10:07:58 AM | 11/10/2017 10:07 AM |
| Contacts | Authorizing Official | Update | | Semenza, Patrick
VP and Chief Financial Officer
7184883715 | Semenza, Patrick
VP and Chief Financial Officer
The Brooklyn Hospital Center
7184883715 | 10/20/2017 8:46 AM |
| Contacts | Primary Contact | Update | | Minlionica, Kathleen
Director of Pharmacy
7182508255 | Minlionica, Kathleen
Director of Pharmacy
The Brooklyn Hospital Center
7182508255 | 10/15/2017 10:14 AM |
| Contacts | Primary Contact | Update | | Schlieder, Katherine
SVP, Clinical Integration
7182506699 | Minlionica, Kathleen
Director of Pharmacy
7182508255 | 8/2/2017 7:13 AM |
| Contacts | Authorizing Official | Insert | | | Semenza, Patrick
VP and Chief Financial Officer
7184883715 | 8/2/2017 7:13 AM |
| Addresses | Main Address | Insert | | |
155 ASHLAND PLACE
2ND FLOOR
BROOKLYN, NY 11201 | 7/25/2017 11:40 AM |
| Contacts | Primary Contact | Update | | Shedwell, Amber
VP Ambulatory Care
7182506702 | Schlieder, Katherine
SVP, Clinical Integration
7182506699 | 8/23/2016 4:24 PM |
| Details | Last Recertification Date | Update | | 8/20/2015 12:00:00 AM | 8/23/2016 12:00:00 AM | 8/23/2016 4:24 PM |
| Contacts | Primary Contact | Update | | Shedwell, Amber
VICE PRESIDENT, AMBULATORY CARE
7182506702 | Shedwell, Amber
VP Ambulatory Care
7182506702 | 5/18/2016 12:12 PM |
| Contacts | Primary Contact | Update | | VASWANI, DAVINA
VICE PRESIDENT, AMBULATORY CARE
7182508653 | Shedwell, Amber
VICE PRESIDENT, AMBULATORY CARE
7182506702 | 5/18/2016 12:10 PM |
| Details | Last Recertification Date | Update | | 8/11/2014 12:00:00 AM | 8/20/2015 12:00:00 AM | 8/20/2015 4:28 PM |
| Contacts | Primary Contact | Update | | DAVIS-NOUGUES, CHRISTIE
DIRECTOR, AMBULATORY SERVICES
7182508653 | VASWANI, DAVINA
VICE PRESIDENT, AMBULATORY CARE
7182508653 | 8/11/2014 10:11 AM |
| Details | Last Recertification Date | Update | | 8/29/2013 9:41:13 AM | 8/11/2014 12:00:00 AM | 8/11/2014 10:11 AM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 8/29/2013 9:41:13 AM | 8/29/2013 9:41 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 5/30/2012 7:30 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 00243614 | 5/30/2012 7:30 AM |
| Medicaid Billing | Medicaid: State | Insert | | | NY | 5/30/2012 7:30 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1326046467 | 5/30/2012 7:30 AM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 5/30/2012 7:30 AM |
| Contacts | Primary Contact | Insert | | | DAVIS-NOUGUES, CHRISTIE
DIRECTOR, AMBULATORY SERVICES
7182508653 | 9/5/2008 4:15 PM |
| Details | Last Recertification Date | Insert | | | | 9/5/2008 3:30 PM |
| Details | Grant Number | Insert | | | | 9/5/2008 3:30 PM |
| Details | 340B ID | Insert | | | DSH330056D | 9/5/2008 3:30 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 9/5/2008 3:30 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 9/5/2008 3:30 PM |
| Details | Medicare Provider Number | Insert | | | 330056 | 9/5/2008 3:30 PM |
| Details | Entity Name | Insert | | | THE BROOKLYN HOSPITAL CENTER | 9/5/2008 3:30 PM |
| Details | Program Code | Insert | | | DSH | 9/5/2008 3:30 PM |
| Details | Entity Subname | Insert | | | CLINIC OPD-1 DENTAL | 9/5/2008 3:30 PM |
| Dates | Participating Approval Date | Insert | | | 9/5/2008 12:00:00 AM | 9/5/2008 3:30 PM |
| Details | State | Insert | | | Active | 9/5/2008 3:30 PM |
| Dates | Registration Date | Insert | | | 9/5/2008 12:00:00 AM | 9/5/2008 3:30 PM |
| Dates | Signed By Date | Insert | | | 9/2/2008 12:00:00 AM | 9/5/2008 3:30 PM |
| Dates | Start Date | Insert | | | 9/5/2008 12:00:00 AM | 9/5/2008 3:30 PM |
| Terminations | Termination Comments | Insert | | | | 9/5/2008 3:30 PM |
| Terminations | Termination Date | Insert | | | | 9/5/2008 3:30 PM |
| Terminations | Termination Effective Date | Insert | | | | 9/5/2008 3:30 PM |
| Terminations | Termination Reason | Insert | | | | 9/5/2008 3:30 PM |