1861759961 NPI number — PHELPS MEMORIAL HOSPITAL ASSOCIATION

Table of content: (NPI 1861759961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861759961 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:
PHELPS AT DOBBS FERRY
Provider Other Organization Name Type Code:
5
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:
1861759961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
362 NORTH BROADWAY, 2ND FLOOR
Provider Second Line Business Mailing Address:
PHELPS MEDICAL PRACTICE
Provider Business Mailing Address City Name:
SLEEPY HOLLOW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10591-1096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-631-2070
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 ASHFORD AVENUE
Provider Second Line Business Practice Location Address:
PHELPS AT DOBBS FERRY
Provider Business Practice Location Address City Name:
DOBBS FERRY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10522-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-478-1384
Provider Business Practice Location Address Fax Number:
914-478-1387
Provider Enumeration Date:
04/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RYKE
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR OF PROFESSIONAL BILLING
Authorized Official Telephone Number:
914-366-3134

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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