Healthcare Provider Details

I. General information

NPI: 1558720235
Provider Name (Legal Business Name): DHCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 E MAIN STREET
HUNTINGTON NY
11743
US

IV. Provider business mailing address

195 E MAIN STREET
HUNTINGTON NY
11743
US

V. Phone/Fax

Practice location:
  • Phone: 631-385-8677
  • Fax: 631-385-0611
Mailing address:
  • Phone: 631-385-8677
  • Fax: 631-385-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA BRIDGET DUPITON
Title or Position: BILLING MANAGER
Credential:
Phone: 631-385-8677