SUFFOLK PRIMARY HEALTH LLC NPI 1174965727

NPI Information

NPI: 1174965727
Provider Name: SUFFOLK PRIMARY HEALTH, LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 33D2137930

Address:
170 OLD COUNTRY RD
RIVERHEAD, NY
ZIP 11901
Phone: (631) 208-4460
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SUFFOLK PRIMARY HEALTH, LLC is a primary care clinic center in Riverhead, NY. SUFFOLK PRIMARY HEALTH, LLC NPI is 1174965727. The provider is registered as an organization entity type.

The provider's business location address is:

170 OLD COUNTRY RD
RIVERHEAD, NY
ZIP 11901-198
Phone: (631) 208-4460
Fax: (631) 208-4462

The provider's authorized official is Kenneth Gaul .
The authorized official title is Sole Member and has the following contact phone number (631) 473-7100.

The CLIA number assigned to this NPI record is 33D2137930 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/24/2013 and was last updated on 4/7/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care		NEW YORK	No
2	261QP2300X	Clinic/Center	Primary Care	5155205R	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5155205R	OTHER	NEW YORK	NYS DOH OPCERT
2	6361	OTHER	NEW YORK	NYS FACILITY ID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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