MEDICARE: GOOD SAMARITAN HOSPITAL MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	5154310N	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5154310N	OTHER	NY	OPERATING CERTIFICATE NUM

General Provider Information

NPI Number	:	1275529612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SAMARITAN HOSPITAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	101 ELM STREET
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782
Country	:	US
Telephone Number	:	631-862-3951
Fax Number	:	631-862-3906

Provider Business Practice Location Address
First Line	:	101 ELM ST
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782-3111
Country	:	US
Telephone Number	:	631-244-2400
Fax Number	:	631-244-2405

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE-CONTINUIN
Name	:	JOHN J HAIGHT
Credential	:
Telephone Number	:	631-862-3951

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	10/28/2015

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Directions to “GOOD SAMARITAN HOSPITAL MEDICAL CENTER ” Practice Location

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