Provider Demographics
NPI:1598821019
Name:BROOKHAVEN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BROOKHAVEN MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHANFELD
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:631-687-4001
Mailing Address - Street 1:101 HOSPITAL RD
Mailing Address - Street 2:ANTICOAGULATION SERVICES
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4870
Mailing Address - Country:US
Mailing Address - Phone:631-687-4001
Mailing Address - Fax:631-687-4004
Practice Address - Street 1:101 HOSPITAL RD
Practice Address - Street 2:ANTICOAGULATION SERVICES
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4870
Practice Address - Country:US
Practice Address - Phone:631-687-4001
Practice Address - Fax:631-687-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302767261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP93291Medicare UPIN