Provider Demographics
NPI:1760799407
Name:ST CHARLES HOSPITAL DME
Entity Type:Organization
Organization Name:ST CHARLES HOSPITAL DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANNIGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:631-465-6213
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-0329
Mailing Address - Country:US
Mailing Address - Phone:631-465-6213
Mailing Address - Fax:631-465-6524
Practice Address - Street 1:200 BELLE TERE ROAD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-474-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST CHARLES HOSPITAL & REHABILITATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5149001H332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies