MEDICARE: BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC.

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
1	174H00000X	Health Educator	5123000H	NY

General Provider Information

NPI Number	:	1306350715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	101 HOSPITAL ROAD
Second Line	:	DIABETES WELLNESS PROGRAM
City	:	PATCHOGUE
State	:	NY
Zip	:	11772-4870
Country	:	US
Telephone Number	:	631-687-4188
Fax Number	:	631-687-2879

Provider Business Practice Location Address
First Line	:	103 W MAIN ST
Second Line	:
City	:	PATCHOGUE
State	:	NY
Zip	:	11772-3003
Country	:	US
Telephone Number	:	631-687-4188
Fax Number	:	631-687-2879

Authorized Official
Title or Position	:	VICE PRESIDENT AND CFO
Name	:	BRENDA J FARRELL
Credential	:
Telephone Number	:	631-654-7175

Provider Enumeration Date	:	11/21/2017
Last Update Date	:	02/06/2020

Similar Medicare Providers

1104823996 — BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC.
Practice Location Address:

103 WEST MAIN STREET
PATCHOGUE, NY
11772-3003

Practice Phone: 631-758-3600
Practice Fax: 631-758-3615

1609877364 — NYU LANGONE HOSPITALS
Practice Location Address:

105 WEST MAIN STREET
PATCHOGUE, NY
11772-3003

Practice Phone: 631-687-2960
Practice Fax: 631-687-2970

1487743480 — NYU LANGONE HOSPITALS
Practice Location Address:

109 WEST MAIN STREET
PATCHOGUE, NY
11772-3003

Practice Phone: 631-687-2828
Practice Fax: 631-687-2879

1730253378 — JULIA FAHEY M.D.
Practice Location Address:

105 W MAIN ST
PATCHOGUE, NY
11772-3003

Practice Phone: 631-687-2969
Practice Fax: 631-687-2970

1164932315 — MRS. JENNY FALTER-SOUTO RN, BSN
Practice Location Address:

109 W MAIN ST
PATCHOGUE, NY
11772-3003

Practice Phone: 631-687-4188
Practice Fax: 631-687-2879

1063058576 — MRS. EILEEN MARY SMITH RN BSN
Practice Location Address:

103 W MAIN ST
PATCHOGUE, NY
11772-3003

Practice Phone: 631-687-4188
Practice Fax:

Directions to “BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.