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General NPI Number Information
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NPI Number | 1104319078
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Entity Type | Organization
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Legal Business Name | SUN RIVER HEALTH INC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 55 HORIZON DR
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City | HUNTINGTON
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State | NY
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Zip | 11743-4436
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Country | US
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Telephone | 631-760-7746
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Fax | 631-760-7748
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Provider Business Mailing Address
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Address Line | PO BOX 5036
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City | WHITE PLAINS
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State | NY
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Zip | 10602-5036
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Country | US
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Telephone | 914-734-8800
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Fax | 914-734-8786
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Authorized Official
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Title or Position | VP INFO/PRACTICE MGMT SYSTEMS
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Name | ADAM LIPTON
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Credential |
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Telephone | 914-384-2375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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