Provider Demographics
NPI:1609964790
Name:UCPA OF SUFFOLK INC
Entity Type:Organization
Organization Name:UCPA OF SUFFOLK INC
Other - Org Name:UCP SUFFOLK HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER UCPA
Authorized Official - Prefix:MS
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-232-0011
Mailing Address - Street 1:250 MARCUS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2018
Mailing Address - Country:US
Mailing Address - Phone:631-439-4314
Mailing Address - Fax:631-439-4319
Practice Address - Street 1:159 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4172
Practice Address - Country:US
Practice Address - Phone:631-439-4314
Practice Address - Fax:631-439-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5157203R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354921Medicaid
NY00354921Medicaid