1093963910 NPI number — COUNTY OF SUFFOLK

Table of content: (NPI 1093963910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093963910 NPI number — COUNTY OF SUFFOLK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SUFFOLK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIV OF SERVICES FOR CHILD W/SPEC NDS EI-SC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093963910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 9006
Provider Second Line Business Mailing Address:
3500 SUNRISE HWY, SUITE 124
Provider Business Mailing Address City Name:
GREAT RIVER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11739-9006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-854-0000
Provider Business Mailing Address Fax Number:
631-854-0108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 LASER CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAUPPAUGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11788-3958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-853-2332
Provider Business Practice Location Address Fax Number:
631-853-3031
Provider Enumeration Date:
09/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TOMARKEN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
COMMISSIONER
Authorized Official Telephone Number:
631-854-0100

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00321875 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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