Healthcare Provider Details

I. General information

NPI: 1508346248
Provider Name (Legal Business Name): BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL RD
PATCHOGUE NY
11772-4870
US

IV. Provider business mailing address

101 HOSPITAL RD
PATCHOGUE NY
11772-4870
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-7100
  • Fax:
Mailing address:
  • Phone: 631-654-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number5123000H
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MARC ADLER
Title or Position: SR. VP - CHIEF OF OPERATIONS
Credential: MD
Phone: 631-654-7177