Healthcare Provider Details

I. General information

NPI: 1235210931
Provider Name (Legal Business Name): BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL ROAD
PATCHOGUE NY
11772-4870
US

IV. Provider business mailing address

101 HOSPITAL ROAD
PATCHOGUE NY
11772-4870
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-7160
  • Fax: 631-447-3749
Mailing address:
  • Phone: 631-654-7100
  • Fax: 631-654-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

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