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General NPI Number Information
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NPI Number | 1003232091
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Entity Type | Organization
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Legal Business Name | SUFFOLK COUNTY CORRECTIONAL FACILITY
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Dates
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Enumeration Date | 03/14/2014
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 100 CENTER DR JAIL MEDICAL
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City | RIVERHEAD
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State | NY
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Zip | 11901-3307
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Country | US
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Telephone | 631-852-2976
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Fax | 631-852-3966
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Provider Business Mailing Address
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Address Line | 100 CENTER DR JAIL MEDICAL
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City | RIVERHEAD
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State | NY
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Zip | 11901-3307
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Country | US
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Telephone | 631-852-2976
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Fax | 631-852-3966
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MAUREEN CROWLY
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Credential | M.D.
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Telephone | 631-852-2976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 301585
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License Number State | NY
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