BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER (NPI# 1902029796) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1902029796 |
Entity Type | Organization |
Organization Name | BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER |
Other Organization Name | BROOKHAVEN MEMORIAL HOSPITAL HEALTH CENTER EAST |
Practice Address |
550 Montauk Highway Shirley NY 11967-2114 |
Mailing Address |
101 Hospital Road Patchogue NY 11772-4870 |
Practice Telephone | 6314903040 |
Practice Fax Number | 6313956340 |
Mailing Telephone | 6316547100 |
Mailing Fax Number | 5163331075 |
Enumeration Date | 2007-04-10 |
Last Update Date | 2015-05-12 |
Authorized Official Name | BRENDA J FARRELL (VICE PRESIDENT & CFO) |
Authorized Official Telephone | 6316547175 |
Is Organization Subpart | Y |
Parent Organization Name | BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NY | 00245529 | 05 |
Other Name | Type Code |
---|---|
Brookhaven Memorial Hospital Health Center East | Other Name - Individual/Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639121825 | Brookhaven Memorial Hospital Medical Center | Emergency Medicine | 101 Hospital Road, Patchogue, NY 11772-4870 | 2006-05-16 |
1609877364 | Brookhaven Memorial Hospital Medical Center | Hospice Care, Community Based | 105 West Main Street, Patchogue, NY 11772-3003 | 2005-08-03 |
1184041899 | Brookhaven Memorial Hospital Medical Center | Family Medicine | 515 Bellport Ave, Bellport, NY 11713-1711 | 2014-03-20 |
1679811293 | Brookhaven Memorial Hospital Medical Center | Clinic/Center | 350 Martha Ave, Bellport, NY 11713-1525 | 2013-01-17 |
1114277449 | Brookhaven Memorial Hospital Medical Center | General Acute Care Hospital | 100 Hospital Rd, Patchogue, NY 11772 | 2012-09-13 |
1508003716 | Brookhaven Memorial Hospital Medical Center | General Acute Care Hospital | 33 Medford Avenue, Suite D, Patchogue, NY 11772-1222 | 2009-01-09 |
1598945735 | Brookhaven Memorial Hospital Medical Center | Clinic/Center | 33 Medford Avenue, Suite D, Patchogue, NY 11772-1222 | 2007-11-05 |
1346429115 | Brookhaven Memorial Hospital Medical Center | Psychiatry & Neurology | 101 Hospital Road, Patchogue, NY 11772-4870 | 2007-10-30 |
1114141298 | Brookhaven Memorial Hospital Medical Center | Clinic/Center | 365 East Main Street, Patchogue, NY 11772-3145 | 2007-04-12 |
1235210931 | Brookhaven Memorial Hospital Medical Center | Clinic/Center | 101 Hospital Road, Patchogue, NY 11772-4870 | 2006-10-18 |
Entity Type | Entity Name | Entity Address |
---|---|---|
New York State Corporations | BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC. | 101 Hospital Rd., Patchogue, New York 11772 |
Street Address |
550 MONTAUK HIGHWAY |
City | SHIRLEY |
State | NY |
Zip Code | 11967-2114 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1891704011 | Anjumon A Amin | Pediatrics | 550 Montauk Highway, Shirley, NY 11967 | 2006-08-05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588149744 | Dawn Kirby | Licensed Practical Nurse | 8 Crestwood Drive, Shirley, NY 11967 | 2018-10-03 |
1538684451 | Crystal E Gambles | Licensed Practical Nurse | 502 Wellwood Drive, Shirley, NY 11967 | 2017-08-11 |
1003330887 | Aura Blum Care, Inc | Licensed Practical Nurse | 436 Auborn Av, Shirley, NY 11967 | 2017-08-02 |
1891239687 | Holly Scott-rodriguez | Behavior Technician | 57 Probst Drive, Shirley, NY 11967 | 2016-12-13 |
1487106357 | Joann C Duran | Licensed Practical Nurse | 320 Decatur Avenue, East Yaphank, NY 11967 | 2016-10-26 |
1053776815 | Andrea Janet Murphy-hamilton | Registered Nurse | 369 Puritan Dr., N Shirley, NY 11967 | 2015-12-22 |
1588039598 | Thomas B Maher | Student in an Organized Health Care Education/Training Program | 483 West End Ave., Shirley, NY 11967 | 2015-12-02 |
1346676707 | Sharon Marie Dougherty | Social Worker | 1250 William Floyd Parkway, Shirley, NY 11967 | 2013-09-17 |
1083964241 | Charlotte Dametra Fleming | Licensed Practical Nurse | 420 Lakepointe Drive, Middleisland, NY 11967 | 2012-09-14 |
1982954277 | Sefika Dimaggio | Registered Nurse | 32 Candido Ave, Shirley, NY 11967 | 2012-09-13 |
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Taxonomy Code | 261QM0801X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Mental Health (Including Community Mental Health Center) |
Definition to come... |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.