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DSH330261A PHELPS MEMORIAL HOSPITAL CENTER (Active)
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Main Details
Name
PHELPS MEMORIAL HOSPITAL CENTER
Subdivision Name
Phelps Memorial Hospital / Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330261A
Medicare Provider Number
330261
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/14/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/18/2016
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Northwell Health
Michele L Cusack, Executive Vice President
(516) 321-6058
Primary Contact
Northwell
Onisis Stefas, VP of Pharmacy Operations
(516) 719-5720
Addresses
Street Address
777 NORTH BROADWAY
Suite 202
Sleepy Hollow, NY 10591-1076
Billing Address
Phelps Memorial Hospital Center
701 North Boradway
Sleepy Hollow, NY 10591
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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