Provider Demographics
NPI:1346391323
Name:SOUTHAMPTON HOSPITAL
Entity Type:Organization
Organization Name:SOUTHAMPTON HOSPITAL
Other - Org Name:SPORTS REHAB EAST HAMPOTN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-726-8514
Mailing Address - Street 1:SPORTS REHAB EAST HAMPTON
Mailing Address - Street 2:470 PANTIGO RD
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937
Mailing Address - Country:US
Mailing Address - Phone:631-329-6420
Mailing Address - Fax:631-329-6824
Practice Address - Street 1:SPORTS REHAB EAST HAMPTON
Practice Address - Street 2:470 PANTIGO RD
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937
Practice Address - Country:US
Practice Address - Phone:631-329-6420
Practice Address - Fax:631-329-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY719515OtherAETNA
NY00274406Medicaid
NY32801OtherCIGNA ORTHONET
NYA1133601OtherOXFORD
NY58418OtherVYTRA
NY=========OtherCIGNA
NY=========Other1199
NY=========OtherIGA
NY=========OtherAETNA
NY=========OtherUHC
NY00274406Medicaid
NY58418OtherVYTRA
NY=========OtherBCBS
NY=========OtherGHI
NY=========OtherHEALTH NET
NY=========OtherMPN
NY=========OtherHIP
NY=========OtherMAGNACARE
NY=========OtherOXFORD
NY00274406Medicaid