Provider Demographics
NPI:1386748598
Name:COUNTY OF SUFFOLK
Entity type:Organization
Organization Name:COUNTY OF SUFFOLK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMMISSIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGSON
Authorized Official - Middle Name:
Authorized Official - Last Name:PIGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-854-0100
Mailing Address - Street 1:3500 SUNRISE HWY
Mailing Address - Street 2:SUITE 124, PO BOX 9006
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-1001
Mailing Address - Country:US
Mailing Address - Phone:631-854-0100
Mailing Address - Fax:
Practice Address - Street 1:300 CENTER DR
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3393
Practice Address - Country:US
Practice Address - Phone:631-852-2680
Practice Address - Fax:631-852-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060910393261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473170Medicaid