1285750737 NPI number — COUNTY OF SUFFOLK

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285750737 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:
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
Provider Other Organization Name Type Code:
3
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:
1285750737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 SUNRISE HWY STE 124
Provider Second Line Business Mailing Address:
POB 9006
Provider Business Mailing Address City Name:
GREAT RIVER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11739-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-854-0182
Provider Business Mailing Address Fax Number:
631-854-0199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 SUNRISE HWY STE 124
Provider Second Line Business Practice Location Address:
POB 9006
Provider Business Practice Location Address City Name:
GREAT RIVER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11739-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-854-0182
Provider Business Practice Location Address Fax Number:
631-854-0199
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
DARLENE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATOR II
Authorized Official Telephone Number:
631-854-0193

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  5155200R , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00473170 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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