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General NPI Number Information
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NPI Number | 1609964790
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Entity Type | Organization
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Legal Business Name | UCPA OF SUFFOLK INC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 159 CARLETON AVE
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City | CENTRAL ISLIP
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State | NY
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Zip | 11722-4172
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Country | US
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Telephone | 631-439-4314
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Fax | 631-439-4319
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Provider Business Mailing Address
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Address Line | 250 MARCUS BLVD
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City | HAUPPAUGE
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State | NY
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Zip | 11788-2018
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Country | US
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Telephone | 631-439-4314
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Fax | 631-439-4319
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER UCPA
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Name | MS. JANINE KLEIN
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Credential |
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Telephone | 631-232-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5157203R
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License Number State | NY
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