Provider Demographics
NPI:1497917983
Name:PHELPS MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:PHELPS MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:PHELPS MEDICAL PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PROFESSIONAL BILLING
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:RYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-269-1763
Mailing Address - Street 1:155 WHITE PLAINS RD
Mailing Address - Street 2:210A
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5523
Mailing Address - Country:US
Mailing Address - Phone:914-269-1763
Mailing Address - Fax:
Practice Address - Street 1:155 WHITE PLAINS RD
Practice Address - Street 2:210A
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5523
Practice Address - Country:US
Practice Address - Phone:914-269-1763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHELPS MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-26
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155904-1207R00000X
NY093343-1207R00000X
NY106477207RN0300X
NY135197-1207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000270Medicare PIN
NYA100000911Medicare PIN
NYA100000275Medicare PIN