Provider Demographics
NPI:1659491975
Name:DEPT. OF HEALTH
Entity Type:Organization
Organization Name:DEPT. OF HEALTH
Other - Org Name:SUFFOLK COUNTY
Other - Org Type:Other Name
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MARTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-853-7373
Mailing Address - Street 1:160 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4022
Mailing Address - Country:US
Mailing Address - Phone:631-447-1288
Mailing Address - Fax:
Practice Address - Street 1:200 WIRELESS BLVD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3933
Practice Address - Country:US
Practice Address - Phone:631-853-7373
Practice Address - Fax:631-853-7380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY376106-1261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone