Healthcare Provider Details

I. General information

NPI: 1043402050
Provider Name (Legal Business Name): CENTRAL SUFFOLK HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 03/19/2015
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: 631-548-6116
  • Fax: 631-548-6007
Mailing address:
  • Phone: 631-548-6116
  • Fax: 631-548-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MITCHELL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 631-548-6064