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General NPI Number Information
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NPI Number | 1144273996
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Entity Type | Organization
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Legal Business Name | DEVELOPMENTAL DISABILITIES INSTITUTE, INC.
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 883 E MAIN ST
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City | RIVERHEAD
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State | NY
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Zip | 11901-2613
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Country | US
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Telephone | 631-284-5500
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Fax | 631-369-7421
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Provider Business Mailing Address
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Address Line | 99 HOLLYWOOD DR
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City | SMITHTOWN
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State | NY
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Zip | 11787-3135
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Country | US
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Telephone | 631-366-2900
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Fax | 631-366-2935
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Authorized Official
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Title or Position | CFO
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Name | SOPHIA SAMUEL
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Credential | CPA
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Telephone | 631-366-2960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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