Provider Demographics
NPI:1679677884
Name:COUNTY OF SUFFOLK
Entity Type:Organization
Organization Name:COUNTY OF SUFFOLK
Other - Org Name:DIV OF SERVICES FOR CHILD W/ SPEC NDS - EI
Other - Org Type:Other Name
Authorized Official - Title/Position:COMMISSIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOMARKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,MPH,MBA,FRCPC,FA
Authorized Official - Phone:631-854-0100
Mailing Address - Street 1:P.O. BOX 9006
Mailing Address - Street 2:3500 SUNRISE HWY, SUITE 124
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-9006
Mailing Address - Country:US
Mailing Address - Phone:631-854-0000
Mailing Address - Fax:631-854-0108
Practice Address - Street 1:50 LASER CT
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-853-2296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473170Medicaid