Basic Information
Provider Information | |||||||||
NPI: | 1811967128 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | OCEANSIDE COUNSELING CENTER,INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 HEALTHY WAY | ||||||||
Address2: |   | ||||||||
City: | OCEANSIDE | ||||||||
State: | NY | ||||||||
PostalCode: | 115721551 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5166323000 | ||||||||
FaxNumber: | 5166323499 | ||||||||
Practice Location | |||||||||
Address1: | 71 HOMECREST CT | ||||||||
Address2: |   | ||||||||
City: | OCEANSIDE | ||||||||
State: | NY | ||||||||
PostalCode: | 115722209 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5167666283 | ||||||||
FaxNumber: | 5167663705 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/26/2006 | ||||||||
LastUpdateDate: | 03/11/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MURPHY | ||||||||
AuthorizedOfficialFirstName: | RICHARD | ||||||||
AuthorizedOfficialMiddleName: | J. | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
AuthorizedOfficialTelephone: | 5166323000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
ID | Type | State | Issuer | Description | 01302501 | 05 | NY |   | MEDICAID |