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DSH330261N PHELPS MEMORIAL HOSPITAL CENTER (Active)
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Main Details
Name
PHELPS MEMORIAL HOSPITAL CENTER
Subdivision Name
Phelps Memorial Hospital Donald R Reed Speech & Hearing Center - Speech Pathology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330261N
Medicare Provider Number
330261
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/6/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/6/2021
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 303
Sleepy Hollow, NY 10591
Billing Address
Phelps Memorial Hospital Center
701 North Broadway
Sleepy Hollow, NY 10591
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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