Provider Demographics
NPI:1982364790
Name:ADULT HEALTH NURSE PRACTITIONER SERVICES OF THE HAMPTONS
Entity Type:Organization
Organization Name:ADULT HEALTH NURSE PRACTITIONER SERVICES OF THE HAMPTONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, ANP-BC, ACHPN
Authorized Official - Phone:845-309-3040
Mailing Address - Street 1:6 FLOCEE LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-3006
Mailing Address - Country:US
Mailing Address - Phone:845-309-3040
Mailing Address - Fax:
Practice Address - Street 1:6 FLOCEE LN
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-3006
Practice Address - Country:US
Practice Address - Phone:845-309-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1043643992Medicaid