Provider Demographics
NPI:1275820961
Name:GOOD SAMARITAN HOSPITAL MEDICAL CENTER
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN BILLING MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANNIGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:631-465-6213
Mailing Address - Street 1:15 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7381
Mailing Address - Country:US
Mailing Address - Phone:631-617-5250
Mailing Address - Fax:
Practice Address - Street 1:15 PARK AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7381
Practice Address - Country:US
Practice Address - Phone:631-617-5250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SAMARITAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-01
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100038918Medicare PIN