Healthcare Provider Details

I. General information

NPI: 1376073908
Provider Name (Legal Business Name): TOWN OF SOUTHAMPTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PONQUOGUE AVE
HAMPTON BAYS NY
11946
US

IV. Provider business mailing address

P.O. BOX 974
HAMPTON BAYS NY
11946
US

V. Phone/Fax

Practice location:
  • Phone: 631-728-1235
  • Fax: 631-723-3061
Mailing address:
  • Phone: 631-728-1235
  • Fax: 631-723-3061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RUSSELL KRATOVILLE
Title or Position: TOWN MGT. SERVICES ADMINISTER
Credential:
Phone: 631-702-1909