Provider Demographics
NPI:1346691003
Name:PHELPS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:PHELPS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-337-2852
Mailing Address - Street 1:400 SAINT NICHOLAS AVE
Mailing Address - Street 2:APT.7M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-7620
Mailing Address - Country:US
Mailing Address - Phone:786-337-2852
Mailing Address - Fax:
Practice Address - Street 1:400 SAINT NICHOLAS AVE
Practice Address - Street 2:APT.7M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-7620
Practice Address - Country:US
Practice Address - Phone:786-337-2852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital