Basic Information
| Provider Information | |||||||||
| NPI: | 1417232760 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC. | ||||||||
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| OtherOrganizationName: | BROOKHAVEN MEMORIAL HOSPITAL PALLIATIVE CARE DEPT. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 HOSPITAL ROAD | ||||||||
| Address2: | |||||||||
| City: | PATCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117724870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316547100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 HOSPITAL ROAD | ||||||||
| Address2: | |||||||||
| City: | PATCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117724870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316547739 | ||||||||
| FaxNumber: | 6314473098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2011 | ||||||||
| LastUpdateDate: | 06/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | FARRELL | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT & CFO | ||||||||
| AuthorizedOfficialTelephone: | 6316547175 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No ID Information.