1972560167 NPI number — SANCTUARY EAST LTD.

Table of content: (NPI 1972560167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972560167 NPI number — SANCTUARY EAST LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANCTUARY EAST LTD.
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:
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:
1972560167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 WILLIAM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST ISLIP
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11730-2330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-224-7700
Provider Business Mailing Address Fax Number:
631-224-7600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 WILLIAM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST ISLIP
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11730-2330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-224-7700
Provider Business Practice Location Address Fax Number:
631-224-7600
Provider Enumeration Date:
04/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
LORENZO
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
631-224-7700

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  070210970 , 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: 160171 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01853901 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004629536 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 105727591 . This is a "UBH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 577470000 . This is a "MAGELLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MH20235 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 023048 . This is a "EMPIRE B/C B/S" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1058710 . This is a "BEACON HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OL987078 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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