Provider Demographics
NPI:1730328279
Name:SUN RIVER HEALTH INC
Entity type:Organization
Organization Name:SUN RIVER HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP INFO/PRACTICE MGMT SYSTEMS
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-384-2375
Mailing Address - Street 1:1037 MAIN ST
Mailing Address - Street 2:ATTN: BILLING DEPT.
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:914-734-8860
Mailing Address - Fax:914-734-8786
Practice Address - Street 1:503 S BROADWAY STE 210
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-6202
Practice Address - Country:US
Practice Address - Phone:914-965-9771
Practice Address - Fax:914-965-4724
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN RIVER HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-06
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473038Medicaid
NY331989Medicare Oscar/Certification
NYW38731Medicare PIN