NPIMap

Brookhaven Memorial Hospital Medical Center

Organization Active NPI Diagnostic Radiology Physician · Patchogue, NY

NPI 1114014065 · NPPES record last updated Mar 25, 2010

Key facts

NPI
1114014065
Entity type
Organization (NPI type 2)
Primary specialty
Diagnostic Radiology Physician 2085R0202X
Legal business name
BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER
Practice address
101 Hospital Road
Patchogue, NY 11772
Phone
(631) 654-7728
Fax
(631) 447-3698
NPI assigned
Oct 10, 2006
Organization subpart
Yes
Parent organization (as reported)
BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER

Authorized official

Name
Kenneth S Schwartz, MD
Title
Director
Phone
(631) 654-7728

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 73

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 73

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NY

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031218000695 NY Part B Supplier - Clinic/Group Practice 9739090051 Receives reassigned benefits from 113 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medford, NY; Westhampton, NY; Shirley, NY; Patchogue, NY; Hauppauge, NY; East Patchogue, NY; Brookhaven, NY; Bellport, NY

National Provider Directory

Part of
Brookhaven Hospital PA

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 2085B0100X
Nuclear Radiology Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 2085N0904X
Diagnostic Radiology Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 2085R0202X Yes
Vascular & Interventional Radiology Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 2085R0204X

Addresses

Primary practice location

101 Hospital Road
Patchogue, NY 11772

Mailing address

P.O. Box 22027
Albany, NY 12201-2027
Phone (631) 321-8043

Other identifiers

IdentifierTypeStateIssuer
02198121MedicaidNY

Other names

  • Brookhaven Memorial Hospital Medical Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 25, 2010.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269475200000",
    "number": "1114014065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 22027",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122012027",
            "telephone_number": "631-321-8043",
            "fax_number": "631-321-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 HOSPITAL ROAD",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "11772",
            "telephone_number": "631-654-7728",
            "fax_number": "631-447-3698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER",
        "enumeration_date": "2006-10-10",
        "last_updated": "2010-03-25",
        "status": "A",
        "authorized_official_last_name": "SCHWARTZ",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "631-654-7728",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02198121",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookhaven Memorial Hospital Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Patchogue, NY

All providers in Patchogue, NY · Diagnostic Radiology Physician in New York

Sources for this page

Verify at the official NPI Registry.