Basic Information
| Provider Information | |||||||||
| NPI: | 1871696724 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUFFOLK CTY DEPT OF HEALTH SERVICES | ||||||||
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| OtherOrganizationName: | DAY RPTG CTR ALCOHOL | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 SUNRISE HWY | ||||||||
| Address2: | SUITE 124, PO BOX 9006 | ||||||||
| City: | GREAT RIVER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117391001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318540196 | ||||||||
| FaxNumber: | 6318540198 | ||||||||
| Practice Location | |||||||||
| Address1: | NORTH COUNTY COMPLEX | ||||||||
| Address2: | BUILDING 16 | ||||||||
| City: | HAUPPAUGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318536281 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 10/22/2012 | ||||||||
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| AuthorizedOfficialLastName: | TOMARKEN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | COMMISSIONER | ||||||||
| AuthorizedOfficialTelephone: | 6318540100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 050411034 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.