Healthcare Provider Details

I. General information

NPI: 1497859615
Provider Name (Legal Business Name): COUNTY OF SUFFOLK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SUNRISE HWY STE 124
GREAT RIVER NY
11739-1001
US

IV. Provider business mailing address

3500 SUNRISE HWY, SUITE 124 P.O. BOX 9006
GREAT RIVER NY
11739-9006
US

V. Phone/Fax

Practice location:
  • Phone: 631-854-0000
  • Fax: 631-854-0108
Mailing address:
  • Phone: 631-854-0000
  • Fax: 631-854-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number5154902L
License Number StateNY

VIII. Authorized Official

Name: DR. JAMES L TOMARKEN
Title or Position: COMMISSIONER
Credential: MSW,MPH,MBA,FRCPC,FA
Phone: 631-854-0100