Organization
BRIGHTWATERS GYNECOLOGY PC
Active
Other names
Phelps Memorial Hospital Association
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELE L CUSACK (SENIOR VICE PRESIDENT & CFO)
(516) 321-6058
Entity
Organization
Contact information
Practice address
755 N BROADWAY, SLEEPY HOLLOW, NY 10591-1075
(914) 302-0100
(914) 302-0600
Mailing address
2000 MARCUS AVE, NEW HYDE PARK, NY 11042-1069
(516) 321-6629
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
07/03/2019
Last updated
08/09/2019
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