NPIMap

Organization Active NPI

Brookhaven Memorial Hosp Psych

  • Neurology Physician
  • Patchogue, NY
National Provider Identifier
1073795209
Registry record updated Nov 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
BROOKHAVEN MEMORIAL HOSP PSYCH
Practice address
101 Hospital Rd
Patchogue, NY 11772-4870
Phone
(631) 447-3076
NPI assigned
Nov 29, 2007
Last updated
Nov 29, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ron Giraulo
Title
VP
Phone
(631) 654-7176

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X Primary

Addresses

Primary practice location

101 Hospital Rd
Patchogue, NY 11772-4870

Mailing address

PO Box 6010
Hauppauge, NY 11788-9010
Phone (631) 840-5347

Other identifiers 1

IdentifierTypeStateIssuer
02244824MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Brookhaven Emer Med Ass13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196294400000",
    "number": "1073795209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6010",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117889010",
            "telephone_number": "631-840-5347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 HOSPITAL RD",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117724870",
            "telephone_number": "631-447-3076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKHAVEN MEMORIAL HOSP PSYCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-29",
        "last_updated": "2007-11-29",
        "status": "A",
        "authorized_official_last_name": "GIRAULO",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "631-654-7176"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02244824",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Patchogue, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.