Healthcare Provider Details

I. General information

NPI: 1851366850
Provider Name (Legal Business Name): HUNTINGTON HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 PARK AVE
HUNTINGTON NY
11743-2787
US

IV. Provider business mailing address

PO BOX 415661
BOSTON MA
02241-5661
US

V. Phone/Fax

Practice location:
  • Phone: 631-547-6392
  • Fax: 631-351-2063
Mailing address:
  • Phone: 631-547-6392
  • Fax: 631-351-2063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

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