Provider Demographics
NPI:1609846948
Name:BROOKS MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:BROOKS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LAROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-363-7207
Mailing Address - Street 1:529 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2514
Mailing Address - Country:US
Mailing Address - Phone:716-363-7215
Mailing Address - Fax:716-363-7228
Practice Address - Street 1:529 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2514
Practice Address - Country:US
Practice Address - Phone:716-363-7215
Practice Address - Fax:716-363-7228
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKS MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-26
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0601000H261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY332400Medicare ID - Type UnspecifiedESRD