Healthcare Provider Details

I. General information

NPI: 1275575052
Provider Name (Legal Business Name): BRUNSWICK HOSPITAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 BROADWAY
AMITYVILLE NY
11701-2711
US

IV. Provider business mailing address

366 BROADWAY
AMITYVILLE NY
11701-2711
US

V. Phone/Fax

Practice location:
  • Phone: 631-789-7000
  • Fax: 631-789-7467
Mailing address:
  • Phone: 631-789-7000
  • Fax: 631-789-7467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number010479
License Number StateNY

VIII. Authorized Official

Name: ROBERT HEISER
Title or Position: PHARMACY DIRECTOR
Credential: R.PH.
Phone: 631-789-7000