Provider Demographics
NPI:1184041899
Name:BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER
Entity Type:Organization
Organization Name:BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER
Other - Org Name:BROOKHAVEN MEMORIAL HOSPITAL BELLPORT PRIMARY CARE CENTER PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICERE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-654-7175
Mailing Address - Street 1:515 BELLPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-1711
Mailing Address - Country:US
Mailing Address - Phone:631-227-6600
Mailing Address - Fax:631-286-8290
Practice Address - Street 1:515 BELLPORT AVE
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-1711
Practice Address - Country:US
Practice Address - Phone:631-227-6600
Practice Address - Fax:631-286-8290
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-20
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty