Provider Demographics
NPI:1700885472
Name:GOOD SAMARITAN HOSPITAL MEDICAL CENTER
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL MEDICAL CENTER
Other - Org Name:GOOD SAMARITAN HOME HEALTH AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-969-8200
Mailing Address - Street 1:15 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7381
Mailing Address - Country:US
Mailing Address - Phone:631-969-8200
Mailing Address - Fax:631-224-8678
Practice Address - Street 1:15 PARK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7381
Practice Address - Country:US
Practice Address - Phone:631-969-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5101600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00274346Medicaid
NY00274346Medicaid