Healthcare Provider Details

I. General information

NPI: 1578941068
Provider Name (Legal Business Name): SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SUNRISE HWY
GREAT RIVER NY
11739-1001
US

IV. Provider business mailing address

3500 SUNRISE HWY
GREAT RIVER NY
11739-1001
US

V. Phone/Fax

Practice location:
  • Phone: 631-854-0182
  • Fax: 631-854-0198
Mailing address:
  • Phone: 631-854-0182
  • Fax: 631-854-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number5155200R
License Number StateNY

VIII. Authorized Official

Name: SUSAN BELL HODOSKY
Title or Position: DIRECTOR OF REVENUE
Credential:
Phone: 631-854-0182