Provider Demographics
NPI:1508261892
Name:SUN RIVER HEALTH INC
Entity Type:Organization
Organization Name:SUN RIVER HEALTH INC
Other - Org Name:HRHCARE PATCHOGUE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP INFO/PRACTICE MGMT SYSTEMS
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-384-2375
Mailing Address - Street 1:PO BOX 5036
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-5036
Mailing Address - Country:US
Mailing Address - Phone:914-734-8800
Mailing Address - Fax:914-734-8786
Practice Address - Street 1:501 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1758
Practice Address - Country:US
Practice Address - Phone:631-866-2030
Practice Address - Fax:631-866-2033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN RIVER HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-29
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NY5901200R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473038Medicaid
NYW38731Medicare PIN