Provider Demographics
NPI:1881015758
Name:BROOKHAVEN MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:BROOKHAVEN MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGY RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:ROSEANNE
Authorized Official - Last Name:DIEGNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:315-885-7926
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-8809
Mailing Address - Country:US
Mailing Address - Phone:631-447-3010
Mailing Address - Fax:631-447-3012
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8809
Practice Address - Country:US
Practice Address - Phone:631-447-3010
Practice Address - Fax:631-447-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital