1285706077 NPI number — PHELPS MEMORIAL HOSPITAL ASSOCIATION

Table of content: (NPI 1285706077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285706077 NPI number — PHELPS MEMORIAL HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHELPS MEMORIAL HOSPITAL ASSOCIATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VIVO HEALTH PHARMACY AT PHELPS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285706077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1983 MARCUS AVE STE 118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11042-1016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-366-1400
Provider Business Mailing Address Fax Number:
914-366-1408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 N BROADWAY
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
SLEEPY HOLLOW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10591-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-366-1400
Provider Business Practice Location Address Fax Number:
914-366-1408
Provider Enumeration Date:
11/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DRUMMOND
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP, CHIEF EXPENSE OFFICER
Authorized Official Telephone Number:
914-366-1400

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 028009 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2068676 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2848479 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".