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General NPI Number Information
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NPI Number | 1417398512
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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 | 07/17/2013
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 1000 MONTAUK HWY
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City | WEST ISLIP
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State | NY
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Zip | 11795-4927
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Country | US
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Telephone | 718-375-6449
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 MONTAUK HWY
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City | WEST ISLIP
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State | NY
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Zip | 11795-4927
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Country | US
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Telephone | 718-374-6449
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Fax |
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Authorized Official
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Title or Position | DR/RESIDENT
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Name | DR. MIRO LATI
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Credential | D.O
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Telephone | 718-375-6449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 281P00000X
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Taxonomy Name | Chronic Disease Hospital
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License Number | AG3434901205
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License Number State | NY
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