Provider Demographics
NPI:1437575396
Name:WINTHROP UNIVERSITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:WINTHROP UNIVERSITY HOSPITAL ASSOCIATION
Other - Org Name:WINTHROP UNIVERSITY CENTER FOR FAMILY DENTAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-663-2311
Mailing Address - Street 1:700 HICKSVILLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3471
Mailing Address - Country:US
Mailing Address - Phone:516-576-5810
Mailing Address - Fax:576-576-5801
Practice Address - Street 1:200 OLD COUNTRY RD
Practice Address - Street 2:SUITE 460
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4235
Practice Address - Country:US
Practice Address - Phone:516-663-2752
Practice Address - Fax:516-663-9373
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental