Provider Demographics
NPI:1376073908
Name:TOWN OF SOUTHAMPTON
Entity Type:Organization
Organization Name:TOWN OF SOUTHAMPTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOWN MGT. SERVICES ADMINISTER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRATOVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-702-1909
Mailing Address - Street 1:P.O. BOX 974
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946
Mailing Address - Country:US
Mailing Address - Phone:631-728-1235
Mailing Address - Fax:631-723-3061
Practice Address - Street 1:25 PONQUOGUE AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946
Practice Address - Country:US
Practice Address - Phone:631-728-1235
Practice Address - Fax:631-723-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care