Healthcare Provider Details

I. General information

NPI: 1114973856
Provider Name (Legal Business Name): CENTRAL SUFFOLK HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ROANOKE AVE
RIVERHEAD NY
11901-2031
US

IV. Provider business mailing address

1300 ROANOKE AVE
RIVERHEAD NY
11901-2031
US

V. Phone/Fax

Practice location:
  • Phone: 631-548-6000
  • Fax: 631-548-6007
Mailing address:
  • Phone: 631-548-6000
  • Fax: 631-548-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5155000N
License Number StateNY

VIII. Authorized Official

Name: MR. RONALD MCMANUS
Title or Position: VP OF OPERATIONS
Credential:
Phone: 631-548-6071