NPIMap

Organization Active NPI

Brightwaters Gynecology PC

Doing business as Phelps Memorial Hospital Association

  • Urology Physician
  • Sleepy Hollow, NY
National Provider Identifier
1316509979
Registry record updated Aug 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
BRIGHTWATERS GYNECOLOGY PC
Doing business as
Phelps Memorial Hospital Association
Practice address
755 N Broadway
Sleepy Hollow, NY 10591-1075
Phone
(914) 302-0100
Fax
(914) 302-0600
NPI assigned
Jul 3, 2019
Last updated
Aug 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2019

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

755 N Broadway
Sleepy Hollow, NY 10591-1075

Mailing address

2000 Marcus Ave
New Hyde Park, NY 11042-1069
Phone (516) 321-6629

Other practice location 1

701 N Broadway
Sleepy Hollow, NY 10591-1096
Phone (516) 302-0100

Other names 1

  • Phelps Memorial Hospital Association Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190916002478 NY Part B Supplier - Clinic/Group Practice 9830428937 Receives reassigned benefits from 14 practitioners
Practice locations: Sleepy Hollow, NY; New York, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1562112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565308800000",
    "number": "1316509979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 MARCUS AVE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421069",
            "telephone_number": "516-321-6629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 N BROADWAY",
            "city": "SLEEPY HOLLOW",
            "state": "NY",
            "postal_code": "105911075",
            "telephone_number": "914-302-0100",
            "fax_number": "914-302-0600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 N Broadway",
            "address_purpose": "LOCATION",
            "city": "Sleepy Hollow",
            "state": "NY",
            "postal_code": "105911096",
            "country_code": "US",
            "telephone_number": "516-302-0100",
            "fax_number": "516-302-0600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRIGHTWATERS GYNECOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-03",
        "last_updated": "2019-08-09",
        "status": "A",
        "authorized_official_last_name": "CUSACK",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "516-321-6058",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phelps Memorial Hospital Association",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Phelps Memorial Hospital Association",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sleepy Hollow, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.