Provider Demographics
NPI:1225218456
Name:BROOKHAVEN MEM HOSP-NUC C
Entity Type:Organization
Organization Name:BROOKHAVEN MEM HOSP-NUC C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHESIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-687-5427
Mailing Address - Street 1:PO BOX 22073
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-2073
Mailing Address - Country:US
Mailing Address - Phone:631-654-7243
Mailing Address - Fax:631-687-2842
Practice Address - Street 1:101 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4870
Practice Address - Country:US
Practice Address - Phone:631-654-7243
Practice Address - Fax:631-687-2842
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKHAVEN MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-05
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5123000H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW70291Medicare PIN