Provider Demographics
NPI:1962770602
Name:SOUTHAMPTON HOSPITAL
Entity type:Organization
Organization Name:SOUTHAMPTON HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:STOEBE
Authorized Official - Suffix:
Authorized Official - Credentials:PT/DPT
Authorized Official - Phone:631-726-8514
Mailing Address - Street 1:PO BOX 1613
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-1613
Mailing Address - Country:US
Mailing Address - Phone:631-726-8514
Mailing Address - Fax:
Practice Address - Street 1:74 OLD RIVERHEAD RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1401
Practice Address - Country:US
Practice Address - Phone:631-288-7767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHAMPTON HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-08
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0344081273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH04447OtherOXFORD
NY32501OtherCIGNA ORTHONET
NYNY0346OtherHEALTH ORTHONET
NY12755OtherAETNA
NY3C4913OtherHEALTHNET
NY58418OtherVYTRA
NYF0105OtherHIP
NY000105OtherEMPIRE
NY6697979OtherGHI
NY00274406Medicaid
NYNY0346OtherHEALTH ORTHONET