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General NPI Number Information
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NPI Number | 1033401211
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN HOSPITAL
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 05/06/2011
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Provider Practice Location Address
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Address Line | 1000 MONTAUK HIGHWAY
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City | WEST ISLIP
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State | NY
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Zip | 11795
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Country | US
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Telephone | 631-376-3069
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 MONTAUK HIGHWAY
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City | WEST ISLIP
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State | NY
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Zip | 11795
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MISS ELIZABETH MARION JAQUAY
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Credential | MSOTR/L
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Telephone | 631-376-3076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 0160601
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License Number State | NY
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