MEDICARE: PHELPS MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1346691003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHELPS MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	400 SAINT NICHOLAS AVE
Second Line	:	APT.7M
City	:	NEW YORK
State	:	NY
Zip	:	10027-7620
Country	:	US
Telephone Number	:	786-337-2852
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 SAINT NICHOLAS AVE
Second Line	:	APT.7M
City	:	NEW YORK
State	:	NY
Zip	:	10027-7620
Country	:	US
Telephone Number	:	786-337-2852
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. CHRISTIAN G GONZALEZ
Credential	:	D.M.D.
Telephone Number	:	786-337-2852

Provider Enumeration Date	:	06/23/2016
Last Update Date	:	06/23/2016

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