Provider Demographics
NPI:1598085508
Name:SUFFOLK COUNTY DOHS JAIL MEDICAL UNIT
Entity Type:Organization
Organization Name:SUFFOLK COUNTY DOHS JAIL MEDICAL UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:GERACI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-852-1869
Mailing Address - Street 1:100 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3307
Mailing Address - Country:US
Mailing Address - Phone:631-852-1987
Mailing Address - Fax:
Practice Address - Street 1:100 CENTER DR
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3307
Practice Address - Country:US
Practice Address - Phone:631-852-1987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3011351-1261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local