Provider Demographics
NPI:1215531215
Name:HAUPPAUGE SC, LLC
Entity type:Organization
Organization Name:HAUPPAUGE SC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-768-1126
Mailing Address - Street 1:4 WESTBROOK CORPORATE CTR STE 900
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5724
Mailing Address - Country:US
Mailing Address - Phone:615-478-3540
Mailing Address - Fax:907-891-7315
Practice Address - Street 1:125 KENNEDY DR STE 300
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4017
Practice Address - Country:US
Practice Address - Phone:615-478-3540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical