Basic Information
| Provider Information | |||||||||
| NPI: | 1194952630 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOOD SAMARITAN HOSPITAL DME | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 329 | ||||||||
| Address2: | |||||||||
| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117950329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314656213 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 MONTAUK HWY | ||||||||
| Address2: | |||||||||
| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117954927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313763000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2009 | ||||||||
| LastUpdateDate: | 06/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | HANNIGAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER PATIENT ACCOUNTS | ||||||||
| AuthorizedOfficialTelephone: | 6314656213 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 5154001H | NY | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.