Provider Demographics
NPI:1942543988
Name:NAVY
Entity Type:Organization
Organization Name:NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:E2/HA
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:SANTIAGO
Authorized Official - Last Name:RODAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-745-7381
Mailing Address - Street 1:43 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02841
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 SMITH RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841-1006
Practice Address - Country:US
Practice Address - Phone:631-745-7381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1103XAmbulatory Health Care FacilitiesClinic/CenterMilitary Ambulatory Procedure Visits Operational (Transportable)