Healthcare Provider Details

I. General information

NPI: 1922430446
Provider Name (Legal Business Name): HUNTINGTON HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 WALL ST
HUNTINGTON NY
11743-2186
US

IV. Provider business mailing address

PO BOX 418204
BOSTON MA
02241-8204
US

V. Phone/Fax

Practice location:
  • Phone: 631-351-2024
  • Fax: 631-351-1581
Mailing address:
  • Phone: 516-883-7100
  • Fax: 516-883-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL FAGAN
Title or Position: CFO/VPF
Credential:
Phone: 631-425-4262