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DSH330221G WYCKOFF HEIGHTS MEDICAL CENTER (Active)
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Main Details
Name
WYCKOFF HEIGHTS MEDICAL CENTER
Subdivision Name
WYCKOFF DOCTORS - GENERAL MEDICINE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330221G
Medicare Provider Number
330221
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/4/2023
Participating Start Date
7/1/2023
Participating Approval Date
4/19/2023
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Wyckoff Heights Medical Center
Vali Gache, Chief Executive Officer
(718) 204-1791
Primary Contact
Wyckoff Heights Medical Center
Joseph S Rumore, Director of Pharmacy
(718) 963-7547 Ext: 7141
Addresses
Street Address
1419 Myrtle Ave
Brooklyn, NY 11237
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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