Provider Demographics
NPI:1508167230
Name:SUFFOLK RESTORATIVE THERAPY & NURSING, LLC
Entity Type:Organization
Organization Name:SUFFOLK RESTORATIVE THERAPY & NURSING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLIMENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-671-4100
Mailing Address - Street 1:340 EAST MONTAUK HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730
Mailing Address - Country:US
Mailing Address - Phone:516-671-4100
Mailing Address - Fax:
Practice Address - Street 1:340 EAST MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730
Practice Address - Country:US
Practice Address - Phone:516-671-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00311188Medicaid
NY00311188Medicaid