Provider Demographics
NPI:1700989050
Name:SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
Entity type:Organization
Organization Name:SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMMISSIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMAYUN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MS
Authorized Official - Phone:631-853-3000
Mailing Address - Street 1:225 RABRO DR
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4241
Mailing Address - Country:US
Mailing Address - Phone:631-853-3000
Mailing Address - Fax:631-853-2927
Practice Address - Street 1:15 HORSEBLOCK PL
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1204
Practice Address - Country:US
Practice Address - Phone:631-854-2552
Practice Address - Fax:631-854-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6919102A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354807Medicaid
NY00354807Medicaid