Provider Demographics
NPI:1619119237
Name:ECONOMIC OPPORTUNITY COUNCIL OF SUFFOLK, INC.
Entity Type:Organization
Organization Name:ECONOMIC OPPORTUNITY COUNCIL OF SUFFOLK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SONGHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-289-2124
Mailing Address - Street 1:31 W MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3034
Mailing Address - Country:US
Mailing Address - Phone:631-289-2124
Mailing Address - Fax:631-289-2178
Practice Address - Street 1:320 CARLETON AVE
Practice Address - Street 2:SUITE 7800
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4506
Practice Address - Country:US
Practice Address - Phone:631-968-8000
Practice Address - Fax:631-968-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01998310Medicaid
NY01494586Medicaid
NY03062879Medicaid
NY02597395Medicaid