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General NPI Number Information
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NPI Number | 1386964492
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Entity Type | Organization
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Legal Business Name | SUFFOLK COUNTY DOHS JAIL MEDICAL UNIT
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 06/11/2010
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Provider Practice Location Address
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Address Line | 100 CENTER DR
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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 | 631-852-1987
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CENTER DR
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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 | 631-852-1987
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. VINCENT GERACI
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Credential | D.O.
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Telephone | 631-852-1869
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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 | F301351-1
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License Number State | NY
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