Provider Demographics
NPI:1891728317
Name:PHELPS MEMORIAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:PHELPS MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PATIENT ACCOUNTS
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:RYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-366-3134
Mailing Address - Street 1:10 LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7712
Mailing Address - Country:US
Mailing Address - Phone:845-562-7995
Mailing Address - Fax:
Practice Address - Street 1:701 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1020
Practice Address - Country:US
Practice Address - Phone:845-562-7995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANJ51Medicare PIN