Healthcare Provider Details

I. General information

NPI: 1407120181
Provider Name (Legal Business Name): PHELPS MEMORIAL HOSPITAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ASHFORD AVE SUITE MW
DOBBS FERRY NY
10522-1823
US

IV. Provider business mailing address

18 ASHFORD AVE SUITE MW
DOBBS FERRY NY
10522-1823
US

V. Phone/Fax

Practice location:
  • Phone: 914-478-1384
  • Fax: 914-478-1387
Mailing address:
  • Phone: 914-478-1384
  • Fax: 914-478-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES A RYKE
Title or Position: DIRECTOR OF PROFESSIONAL BILLING
Credential:
Phone: 914-366-3134