Healthcare Provider Details

I. General information

NPI: 1841637741
Provider Name (Legal Business Name): CENTRAL SUFFOLK HOSPTIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 08/31/2016
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: 631-548-6101
  • Fax: 631-548-6007
Mailing address:
  • Phone: 631-548-6101
  • Fax: 631-548-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL O'DONNELL
Title or Position: SENIOR VP FINANCE/CFO
Credential:
Phone: 631-548-6000