NPIMap

Organization Active NPI

Phelps Memorial Hospital Association

  • Rehabilitation Hospital
  • Sleepy Hollow, NY
National Provider Identifier
1114189636
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation HospitalTaxonomy code 283X00000X
Legal business name
PHELPS MEMORIAL HOSPITAL ASSOCIATION
Practice address
701 N Broadway
Sleepy Hollow, NY 10591-1020
Phone
(914) 366-1004
Fax
(914) 366-1522
NPI assigned
Jun 26, 2008
Last updated
Jul 31, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

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

Authorized official

Name
Mrs. Michele Lee Cusack
Title
Senior Vice President & Cfo
Phone
(516) 321-6058

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital 283X00000X Primary

Addresses

Primary practice location

701 N Broadway
Sleepy Hollow, NY 10591-1020

Mailing address

972 Brush Hollow Rd FL 5
Westbury, NY 11590-1740
Phone (516) 846-6065

Other identifiers 1

IdentifierTypeStateIssuer
33-T261OtherMEDICARE SUB PROVIDER

Other names 1

  • Rehabilitation Sub Provider Hospital Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041014000046 NY Part A Provider - Hospital 1658283981 Practice locations: Sleepy Hollow, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114189636. Details of each certification follow.

Hospital certification: CCN 33T261

Legal name
PHELPS MEMORIAL HOSPITAL ASSOCIATION
Doing business as
REHABILITATION HOSPITAL SUB PROVIDER HOSPTIAL
Organization structure
CorporationNon-profit
Incorporated
Nov 4, 1954 in NY
Enrollment address
701N Broadway
Sleepy Hollow, NY 10591-1020
Hospital Rehabilitation Unit
Hospital subgroups
Acute care, Rehabilitation, Rehabilitation unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Phelps Memorial HospitalCCN 33T261 · All quality measures
Ownership
Non-profit
Certified
Jan 1, 1986

National Provider Directory

National Provider Directory
Tax ID family
Phelps Mem Hosp15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 32

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Glenn Kaufman Individual Corporate OfficerBoard Member Nov 25, 2014
Leonard B Fogel Individual Corporate DirectorVP Managed Care Nov 25, 2014
Bard E Bunaes Individual Corporate Officer Feb 17, 2015
Sanda Carniciu Individual Corporate OfficerBoard Member Nov 25, 2014
Daniel Blum Individual Corporate OfficerPresident Ceo Nov 25, 2014
W-2 Managing EmployeePresident Ceo Nov 25, 2014
Northwell, Inc. Organization, Westbury, NY Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2024 100%
Richard J Sinni Individual Corporate OfficerBoard Member Chair Nov 25, 2014
Janet M Goldberg Individual Corporate DirectorAsst VP of Nursing Nov 25, 2014
Aubrey E Hawes Individual Corporate OfficerBoard Member Nov 25, 2014
Jussi Maijala Individual Corporate DirectorVP of Human Resources Nov 25, 2014
Lawrence L Faltz Individual Corporate DirectorSr VP Medical Director Nov 25, 2014
David W Coulam Individual Corporate OfficerBoard Member Nov 25, 2014
Sean F.X. Dugan Individual Corporate OfficerBoard Member Vice Chair Nov 25, 2014
Robert R Lane Individual Corporate DirectorVP of Development Nov 25, 2014
Mark Frederich Individual Corporate OfficerBoard Member Nov 25, 2014
Northwell Healthcare Inc Organization, Westbury, NY Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Jan 1, 2015
Operational/Managerial Control Jan 1, 2015 100%
William D Reifer Individual Corporate DirectorVP of Quality Nov 25, 2014
James a Goldsmith Individual Corporate OfficerBoard Member Apr 25, 2007
Rebecca Srole Individual Corporate OfficerBoard Member Nov 25, 2014
Northwell Health Inc Organization, Westbury, NY Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2015 100%
Franklin H Zimmerman Individual Corporate OfficerBoard Member Nov 25, 2014
Betty J Albertson Individual Corporate OfficerBoard Member Nov 25, 2014
Diane G Potter Individual Corporate OfficerBoard Member Nov 25, 2014
Mary T McDermott Individual Corporate DirectorVP Nursing Nov 25, 2014
Kenneth J Miller Individual Corporate OfficerBoard Member Nov 25, 2014
Louis Wachtel Individual Corporate OfficerBoard Member Nov 25, 2014
Alfred Mascia Individual Corporate OfficerBoard Member Nov 25, 2014
Richard H Becker Individual Corporate DirectorVP of Physician Admin Nov 25, 2014
Christy E Joyce Individual Corporate OfficerBoard Member Nov 25, 2014
Richard E Peress Individual Corporate OfficerBoard Member Nov 25, 2014
John L Barnes Individual Corporate OfficerBoard Member Nov 25, 2014
Michele L Cusack Individual Corporate OfficerSenior Vice President & Cfo Sep 12, 2017

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 42

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 42

Practitioners & affiliated clinicians

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1114189636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "972 BRUSH HOLLOW RD FL 5",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115901740",
            "telephone_number": "516-846-6065",
            "fax_number": "516-876-5572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N BROADWAY",
            "city": "SLEEPY HOLLOW",
            "state": "NY",
            "postal_code": "105911020",
            "telephone_number": "914-366-1004",
            "fax_number": "914-366-1522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHELPS MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-26",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A",
        "authorized_official_last_name": "CUSACK",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "516-321-6058",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE SUB PROVIDER",
            "identifier": "33-T261",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.1",
            "affiliationName": "Bluemark",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "40 Sunset Ridge Rd",
            "city": "New Paltz",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125611036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Rehabilitation Sub Provider Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sleepy Hollow, NY

Sources for this page

Verify at the official NPI Registry.