1740447135 NPI number — MS. EILEEN MARY DIMARZO CRC

Table of content: MS. EILEEN MARY DIMARZO CRC (NPI 1740447135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740447135 NPI number — MS. EILEEN MARY DIMARZO CRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIMARZO
Provider First Name:
EILEEN
Provider Middle Name:
MARY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1740447135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6100 SUFFOLK COUNTY DEPT. HEALTH
Provider Second Line Business Mailing Address:
BLG 16 NORTH COUNTY COMPLEX DAY REPORTING CENTER
Provider Business Mailing Address City Name:
HAUPPAUGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-853-6281
Provider Business Mailing Address Fax Number:
631-853-6254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
Provider Second Line Business Practice Location Address:
BLG 16 NORTH COUNTY COMPLEX DAY REPORTING CENTER
Provider Business Practice Location Address City Name:
HAUPPAUGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-853-6281
Provider Business Practice Location Address Fax Number:
631-853-6254
Provider Enumeration Date:
05/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  C-042354 , 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)