MEDICARE: PHELPS FACULTY MEDICAL AFFILIATES, UNIVERSITY FACULTY PRACTICE CORPORA

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1912853722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHELPS FACULTY MEDICAL AFFILIATES, UNIVERSITY FACULTY PRACTICE CORPORA

Provider Business Mailing Address
First Line	:	25 SMITH ST STE 210
Second Line	:
City	:	NANUET
State	:	NY
Zip	:	10954-2971
Country	:	US
Telephone Number	:	845-623-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 SMITH ST STE 210
Second Line	:
City	:	NANUET
State	:	NY
Zip	:	10954-2971
Country	:	US
Telephone Number	:	845-623-7100
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SHARLENE BRONSTORPH
Credential	:
Telephone Number	:	516-850-3999

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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