Provider Demographics
NPI:1922430446
Name:HUNTINGTON HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:HUNTINGTON HOSPITAL ASSOCIATION
Other - Org Name:HUNTINGTON HOSPITAL BARIATRIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/VPF
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-425-4262
Mailing Address - Street 1:PO BOX 418204
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8204
Mailing Address - Country:US
Mailing Address - Phone:516-883-7100
Mailing Address - Fax:516-883-7474
Practice Address - Street 1:224 WALL ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2186
Practice Address - Country:US
Practice Address - Phone:631-351-2024
Practice Address - Fax:631-351-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty