Provider Demographics
NPI:1003232091
Name:SUFFOLK COUNTY CORRECTIONAL FACILITY
Entity Type:Organization
Organization Name:SUFFOLK COUNTY CORRECTIONAL FACILITY
Other - Org Name:DEPARTMENT OF HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-852-2976
Mailing Address - Street 1:100 CENTER DR
Mailing Address - Street 2:JAIL MEDICAL
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3307
Mailing Address - Country:US
Mailing Address - Phone:631-852-2976
Mailing Address - Fax:631-852-3966
Practice Address - Street 1:100 CENTER DR
Practice Address - Street 2:JAIL MEDICAL
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3307
Practice Address - Country:US
Practice Address - Phone:631-852-2976
Practice Address - Fax:631-852-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301585261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service