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NPI Code Detail

MEDICARE: BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER

MEDICARE: BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114141298
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER
Provider Business Mailing Address
First Line : 101 HOSPITAL ROAD
Second Line :
City : PATCHOGUE
State : NY
Zip : 11772-4870
Country : US
Telephone Number : 631-654-7100
Fax Number : 516-333-1075
Provider Business Practice Location Address
First Line : 365 EAST MAIN STREET
Second Line :
City : PATCHOGUE
State : NY
Zip : 11772-3145
Country : US
Telephone Number : 631-866-2030
Fax Number : 631-687-1830
Authorized Official
Title or Position : VICE PRESIDENT & CFO
Name : BRENDA J FARRELL
Credential :
Telephone Number : 631-654-7175
Provider Enumeration Date : 04/12/2007
Last Update Date : 05/12/2015

Similar Medicare Providers

1134124910 — DAVID A EAGLE M.D.
Practice Location Address:
365 E MAIN ST
PATCHOGUE, NY
11772-3145
Practice Phone: 631-751-3000
Practice Fax:
1831152586 — ANDREW ZAW LIN M.D.
Practice Location Address:
365 E MAIN ST
PATCHOGUE, NY
11772-3145
Practice Phone: 631-854-1300
Practice Fax: 631-854-1269
1326091307 — BARBARA CHITKARA LCSW
Practice Location Address:
365 E MAIN ST
PATCHOGUE, NY
11772-3145
Practice Phone: 631-854-1222
Practice Fax: 631-854-1226
1801990015 — COUNTY OF SUFFOLK
Practice Location Address:
365 E MAIN ST
PATCHOGUE, NY
11772-3145
Practice Phone: 631-854-1200
Practice Fax: 631-854-1310
1417046921 — DR. ZAIWANG PAUL JIN MD
Practice Location Address:
365 E MAIN ST
PATCHOGUE, NY
11772-3145
Practice Phone: 631-854-1222
Practice Fax: 631-854-1226
1336221233 — DR. KANISTA MENIKE BASNAYAKE M.D.
Practice Location Address:
365 E MAIN ST , SOUTH BROOKHAVEN HEALTH CENTER WEST
PATCHOGUE, NY
11772-3145
Practice Phone: 631-854-1281
Practice Fax:

Directions to “BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER ” Practice Location

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