MEDICARE: COUNTY OF SUFFOLK

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	261Q00000X	Clinic/Center

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

General Provider Information

NPI Number	:	1992809107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF SUFFOLK

Provider Business Mailing Address
First Line	:	P.O. BOX 9006
Second Line	:	3500 SUNRISE HWY, SUITE 124
City	:	GREAT RIVER
State	:	NY
Zip	:	11739-9006
Country	:	US
Telephone Number	:	631-854-0000
Fax Number	:	631-854-0108

Provider Business Practice Location Address
First Line	:	82 MIDDLE COUNTRY RD
Second Line	:
City	:	CORAM
State	:	NY
Zip	:	11727-4411
Country	:	US
Telephone Number	:	631-854-2301
Fax Number	:

Authorized Official
Title or Position	:	COMMISSIONER
Name	:	DR. JAMES L TOMARKEN
Credential	:	MSW,MPH,MBA,FRCPC,FA
Telephone Number	:	631-854-0100

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	10/25/2012

Similar Medicare Providers

1114904125 — MRS. JANET AUDREY STONE NP, CNM
Practice Location Address:

82 MIDDLE COUNTRY RD , ELSIE OWENS HEALTH CENTER - HRHCARE, INC.
CORAM, NY
11727-4411

Practice Phone: 631-320-2220
Practice Fax: 631-698-3570

1720044258 — DR. MUHAMMAD T KHAN M.D.
Practice Location Address:

82 MIDDLE COUNTRY RD , ELSIE OWENS HEALTH CENTER(CORAM) - HRHC, INC.
CORAM, NY
11727-4411

Practice Phone: 631-320-2220
Practice Fax: 631-698-8570

1689789216 — DOUGLAS GABRIELE M.D.
Practice Location Address:

82 MIDDLE COUNTRY RD
CORAM, NY
11727-4411

Practice Phone: 631-854-2252
Practice Fax:

1689778847 — MS. ALYSA FERGUSON RD CDN
Practice Location Address:

82 MIDDLE COUNTRY RD
CORAM, NY
11727-4411

Practice Phone: 631-854-2333
Practice Fax:

1710083498 — MRS. JENNIFER LOUISE HYMAN RD
Practice Location Address:

82 MIDDLE COUNTRY RD
CORAM, NY
11727-4411

Practice Phone: 631-854-2333
Practice Fax:

1174678825 — MILOSLAVA ANDRST MD
Practice Location Address:

82 MIDDLE COUNTRY RD , ELSIE OWENS NORTH BROOKHAVEN HEALTH CENTER
CORAM, NY
11727-4411

Practice Phone: 631-854-2301
Practice Fax: 631-854-2298

Directions to “COUNTY OF SUFFOLK ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.