Healthcare Provider Details

I. General information

NPI: 1265346977
Provider Name (Legal Business Name): DEVELOPMENTAL DISABILITIES INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 HOLLYWOOD DR
SMITHTOWN NY
11787-3135
US

IV. Provider business mailing address

99 HOLLYWOOD DR
SMITHTOWN NY
11787-3135
US

V. Phone/Fax

Practice location:
  • Phone: 631-366-2953
  • Fax:
Mailing address:
  • Phone: 631-366-2953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIM M KUBASEK
Title or Position: CEO
Credential:
Phone: 631-366-2965