Organization
JOHN T. MATHER MEMORIAL HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELE L CUSACK (EVP & CFO)
(516) 321-6058
Entity
Organization
Contact information
Practice address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2119
(631) 473-1320
(631) 686-1459
Mailing address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2190
(631) 473-1320
(631) 473-5254
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
5149000
NY
282N00000X
General Acute Care Hospital
Primary
5149000
NY
314000000X
Skilled Nursing Facility
5149000
NY
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00274364
—
NY
05
—
100822
—
WA
05
—
110851658
—
PA
05
—
1206575
—
MA
05
—
21920
—
MD
05
—
3044310
—
CT
05
—
3300185
—
NC
05
—
6004504
—
NJ
05
—
HSP32196
—
CA
05
—
HSP42196
—
CA
Enumeration date
05/27/2005
Last updated
07/28/2025
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