NPIMap

Organization Active NPI

Brookhaven Memorial Hospital Medical Center, Inc.

Doing business as Long Island Community Hospital

  • Psychiatry Physician
  • Patchogue, NY
National Provider Identifier
1346429115
Registry record updated Jun 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC.
Doing business as
Long Island Community Hospital
Practice address
101 Hospital Road
Patchogue, NY 11772-4870
Phone
(631) 654-7760
Fax
(631) 447-3044
NPI assigned
Oct 30, 2007
Last updated
Jun 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2022

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

Authorized official

Name
Brenda J Farrell
Title
Vice President & Cfo
Phone
(631) 654-7175

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

101 Hospital Road
Patchogue, NY 11772-4870

Mailing address

101 Hospital Road
Patchogue, NY 11772-4870
Phone (631) 654-7100

Other identifiers 1

IdentifierTypeStateIssuer
02244824MedicaidNY

Other names 2

  • Long Island Community Hospital Doing business as
  • Brookhaven Memorial Hospital Psychiatric Physicians Other name

Medicare participation

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

Enrollment records 1

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654128000000",
    "number": "1346429115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 HOSPITAL ROAD",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117724870",
            "telephone_number": "631-654-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 HOSPITAL ROAD",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117724870",
            "telephone_number": "631-654-7760",
            "fax_number": "631-447-3044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-30",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A",
        "authorized_official_last_name": "FARRELL",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "631-654-7175"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02244824",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Long Island Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brookhaven Memorial Hospital Psychiatric Physicians",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Brookhaven Memorial Hospital Psychiatric Physicians",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jun 2, 2022; 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.