Healthcare Provider Details

I. General information

NPI: 1013724061
Provider Name (Legal Business Name): NYU LANGONE HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL RD
PATCHOGUE NY
11772-4870
US

IV. Provider business mailing address

101 HOSPITAL RD
PATCHOGUE NY
11772-4870
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-7175
  • Fax:
Mailing address:
  • Phone: 631-654-7175
  • Fax: 631-654-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00245529
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MR. WESLEY A SMITH
Title or Position: VP REVENUE CYCLE
Credential:
Phone: 800-237-6977