Healthcare Provider Details

I. General information

NPI: 1700989050
Provider Name (Legal Business Name): SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HORSEBLOCK PL
FARMINGVILLE NY
11738-1204
US

IV. Provider business mailing address

225 RABRO DR
HAUPPAUGE NY
11788-4241
US

V. Phone/Fax

Practice location:
  • Phone: 631-854-2552
  • Fax: 631-854-2550
Mailing address:
  • Phone: 631-853-3000
  • Fax: 631-853-2927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6919102A
License Number StateNY

VIII. Authorized Official

Name: DR. HUMAYUN J CHAUDHRY
Title or Position: COMMISSIONER
Credential: D.O., M.S.
Phone: 631-853-3000