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General NPI Number Information
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NPI Number | 1881015758
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 12/19/2013
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Last Update Date | 12/19/2013
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Provider Practice Location Address
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Address Line | 100 HOSPITAL RD SUITE 201
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-8809
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Country | US
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Telephone | 631-447-3010
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Fax | 631-447-3012
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Provider Business Mailing Address
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Address Line | 100 HOSPITAL RD SUITE 201
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-8809
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Country | US
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Telephone | 631-447-3010
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Fax | 631-447-3012
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Authorized Official
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Title or Position | RADIOLOGY RESIDENT
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Name | DR. BERNADETTE ROSEANNE DIEGNAN
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Credential | D.O.
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Telephone | 315-885-7926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State | NY
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