Healthcare Provider Details

I. General information

NPI: 1194748368
Provider Name (Legal Business Name): BRUNSWICK HOSPITAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 LOUDEN AVE
AMITYVILLE NY
11701-2711
US

IV. Provider business mailing address

81 LOUDEN AVE
AMITYVILLE NY
11701-2711
US

V. Phone/Fax

Practice location:
  • Phone: 631-789-7225
  • Fax: 631-789-4929
Mailing address:
  • Phone: 631-789-5758
  • Fax: 631-789-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number6423021
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: HARVEY GERALD GERSTEN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 631-789-5758