BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER (NPI# 1114014065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114014065 |
| Entity Type | Organization |
| Organization Name | BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER |
| Other Organization Name | BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER |
| Practice Address |
101 Hospital Road Patchogue NY 11772 |
| Mailing Address |
P.o. Box 22027 Albany NY 12201-2027 |
| Practice Telephone | 6316547728 |
| Practice Fax Number | 6314473698 |
| Mailing Telephone | 6313218043 |
| Mailing Fax Number | 6313214235 |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2010-03-25 |
| Authorized Official Name | KENNETH S SCHWARTZ (DIRECTOR) |
| Authorized Official Telephone | 6316547728 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085B0100X |
Radiology Specialization: Body Imaging |
Allopathic & Osteopathic Physicians | ||
| N | 2085N0904X |
Radiology Specialization: Nuclear Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians | ||
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 02198121 | 05 |
| Other Name | Type Code |
|---|---|
| Brookhaven Memorial Hospital Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639121825 | Brookhaven Memorial Hospital Medical Center | Emergency Medicine | 101 Hospital Road, Patchogue, NY 11772-4870 | 2006-05-16 |
| 1609877364 | Brookhaven Memorial Hospital Medical Center | Hospice Care, Community Based | 105 West Main Street, Patchogue, NY 11772-3003 | 2005-08-03 |
| 1184041899 | Brookhaven Memorial Hospital Medical Center | Family Medicine | 515 Bellport Ave, Bellport, NY 11713-1711 | 2014-03-20 |
| 1679811293 | Brookhaven Memorial Hospital Medical Center | Clinic/Center | 350 Martha Ave, Bellport, NY 11713-1525 | 2013-01-17 |
| 1114277449 | Brookhaven Memorial Hospital Medical Center | General Acute Care Hospital | 100 Hospital Rd, Patchogue, NY 11772 | 2012-09-13 |
| 1508003716 | Brookhaven Memorial Hospital Medical Center | General Acute Care Hospital | 33 Medford Avenue, Suite D, Patchogue, NY 11772-1222 | 2009-01-09 |
| 1598945735 | Brookhaven Memorial Hospital Medical Center | Clinic/Center | 33 Medford Avenue, Suite D, Patchogue, NY 11772-1222 | 2007-11-05 |
| 1346429115 | Brookhaven Memorial Hospital Medical Center | Psychiatry & Neurology | 101 Hospital Road, Patchogue, NY 11772-4870 | 2007-10-30 |
| 1114141298 | Brookhaven Memorial Hospital Medical Center | Clinic/Center | 365 East Main Street, Patchogue, NY 11772-3145 | 2007-04-12 |
| 1902029796 | Brookhaven Memorial Hospital Medical Center | Clinic/Center | 550 Montauk Highway, Shirley, NY 11967-2114 | 2007-04-10 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC. | 101 Hospital Rd., Patchogue, New York 11772 |
| Street Address |
101 HOSPITAL ROAD |
| City | PATCHOGUE |
| State | NY |
| Zip Code | 11772 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639121825 | Brookhaven Memorial Hospital Medical Center | Emergency Medicine | 101 Hospital Road, Patchogue, NY 11772-4870 | 2006-05-16 |
| 1225584204 | Michael Kirk | Student in an Organized Health Care Education/Training Program | 101 Hospital Road, Patchogue, NY 11772 | 2016-08-30 |
| 1194100537 | Dimple Puthethukudi George | Nurse Practitioner | 101 Hospital Road, Brook Haven Hospital Medical Center, Patchogue, NY 11772 | 2015-07-28 |
| 1417232760 | Brookhaven Memorial Hospital Medical Center, Inc. | Internal Medicine | 101 Hospital Road, Patchogue, NY 11772-4870 | 2011-10-19 |
| 1073824454 | Felix James Grucci IIi | Neuromusculoskeletal Medicine & OMM | 101 Hospital Road, Access Center, Patchogue, NY 11772-4870 | 2010-06-30 |
| 1346429115 | Brookhaven Memorial Hospital Medical Center | Psychiatry & Neurology | 101 Hospital Road, Patchogue, NY 11772-4870 | 2007-10-30 |
| 1487843090 | Brookhaven Memorial Hospital Medical Center, Inc. | Physician Assistant | 101 Hospital Road, Patchogue, NY 11772-4870 | 2007-10-19 |
| 1528133147 | Brookhaven Memorial Hospital Medical Center, Inc. | Psychiatric Unit | 101 Hospital Road, Patchogue, NY 11772-4870 | 2006-11-21 |
| 1235210931 | Brookhaven Memorial Hospital Medical Center | Clinic/Center | 101 Hospital Road, Patchogue, NY 11772-4870 | 2006-10-18 |
| 1356375083 | Diane Rosario | Physician Assistant | 101 Hospital Road, Brookhaven Memorial Hospital, Patchogue, NY 11772 | 2006-07-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205447224 | Amita Vipul Patel | Nurse Practitioner | Longlsland Community Hospital, 101 Hospital Rd, Patchogue, NY 11772 | 2020-08-13 |
| 1609491968 | Sanjib Dey | Family Medicine | Brookhaven Nephrology Associates, 260 E. Patchogue-yaphank Rd., Patchogue, NY 11772 | 2020-06-12 |
| 1992297204 | Camila Bueno-sanchez | Student in an Organized Health Care Education/Training Program | 676 S Country Rd, East Patchogue, NY 11772 | 2018-06-01 |
| 1184115859 | Premier Endodontics of Patchogue | Dentist | 44 Medford Avenue, Patchogue, NY 11772 | 2018-05-29 |
| 1801386453 | Franklin Ikechukwu Ugbode | Student in an Organized Health Care Education/Training Program | 100 Hospital Road Suite 201, Patchogue, NY 11772 | 2018-05-18 |
| 1508372335 | Stephanie Vanschaick | Counselor | 450 Waverly Ave Ste 11, Patchogue, NY 11772 | 2017-12-15 |
| 1578074498 | Chrystal Lee Curran | Specialist | 1116 Main Road, Aquebogue, NY 11772 | 2017-10-18 |
| 1013457712 | Candyce Fahner | Registered Nurse | 22 Haig Ave, E Patchogue, NY 11772 | 2017-02-28 |
| 1992251631 | Vanessa Lynn Petoello | Nurse Practitioner | 107 N/ Ocean Ave, Suite G, Patchogue, NY 11772 | 2016-09-01 |
| 1811343809 | Andrew Vanderlofske | Nurse Practitioner | 144 North Ocean Avenue, Patchogue, NY 11772 | 2016-05-09 |
| Find all providers in zip 11772 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689101875 | Main Street Medical Imaging, PC | Radiology | 239 E Main St Ste A, Patchogue, NY 11772-3105 | 2017-05-18 |
| 1114900925 | Bonnie Rosen | Radiology | 77 Medford Ave, Patchogue, NY 11772-1281 | 2005-11-25 |
| 1326021163 | David Weltman | Radiology | 101 Hospital Rd., Patchogue, NY 11772-0000 | 2005-11-25 |
| 1740758382 | Brianna Salvia | Radiology | 122 W Roe Blvd, Patchogue, NY 11772-2569 | 2018-11-12 |
| 1831459684 | Parkway Imaging & Diagnostic PC | Radiology | 450 Waverly Ave, Patchogue, NY 11772-1555 | 2012-05-25 |
| 1528341203 | Eric Fabian Greif | Radiology | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2011-09-20 |
| 1356413785 | Victor Mandanas | Radiology | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2006-11-14 |
| 1952314650 | Frank Peter Lombardo | Radiology | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2006-08-14 |
| 1285659649 | Hamid M Alam | Radiology | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2006-07-13 |
| 1417928060 | Arlene Sussman | Radiology | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2006-01-31 |
| Find all providers in PATCHOGUE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.