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General NPI Number Information
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NPI Number | 1447487988
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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 | 06/11/2009
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Last Update Date | 11/04/2019
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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 | 631-376-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 329
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City | WEST ISLIP
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State | NY
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Zip | 11795-0329
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Country | US
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Telephone | 631-465-6213
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Fax |
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Authorized Official
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Title or Position | MANAGER PATIENT ACCOUNTS
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Name | MR. DAVID M HANNIGAN
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5154001H
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License Number State | NY
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