Provider Demographics
NPI:1578941068
Name:SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
Entity Type:Organization
Organization Name:SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:BELL
Authorized Official - Last Name:HODOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-854-0182
Mailing Address - Street 1:3500 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-1001
Mailing Address - Country:US
Mailing Address - Phone:631-854-0182
Mailing Address - Fax:631-854-0198
Practice Address - Street 1:3500 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:GREAT RIVER
Practice Address - State:NY
Practice Address - Zip Code:11739-1001
Practice Address - Country:US
Practice Address - Phone:631-854-0182
Practice Address - Fax:631-854-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5155200R261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health