Organization
DEVELOPMENTAL DISABILITIES INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOPHIA SAMUEL CPA (CFO)
(631) 366-2960
Entity
Organization
Contact information
Practice address
25 LITTLE PLAINS RD, HUNTINGTON, NY 11743-4550
(631) 366-2969
Mailing address
99 HOLLYWOOD DR, SMITHTOWN, NY 11787-3135
(631) 366-2960
(631) 366-5873
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
6917319
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6917319
OPERATING CERTFICATE
NY
Enumeration date
06/19/2014
Last updated
06/19/2014
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