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General NPI Number Information
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NPI Number | 1275820961
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN HOSPITAL MEDICAL CENTER
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 15 PARK AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-7381
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Country | US
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Telephone | 631-617-5250
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Fax |
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Provider Business Mailing Address
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Address Line | 15 PARK AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-7381
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Country | US
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Telephone | 631-617-5250
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN BILLING MGR
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Name | MR. DAVID M HANNIGAN JR.
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Credential |
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Telephone | 631-465-6213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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