Provider Demographics
NPI:1124224084
Name:SAYVILLE PROJECT - SUNY STONY BROOK
Entity Type:Organization
Organization Name:SAYVILLE PROJECT - SUNY STONY BROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIO
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:631-563-2290
Mailing Address - Street 1:640 JOHNSON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-2624
Mailing Address - Country:US
Mailing Address - Phone:631-563-2290
Mailing Address - Fax:631-563-2360
Practice Address - Street 1:640 JOHNSON AVE STE 2
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2624
Practice Address - Country:US
Practice Address - Phone:631-563-2290
Practice Address - Fax:631-563-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01571851Medicaid