Organization
GOOD SAMARITAN HOSPITAL MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM ALLISON (CHIEF FINANCIAL OFFICER)
(631) 376-4003
Entity
Organization
Contact information
Practice address
929 SUNRISE HWY, BAY SHORE, NY 11706-5907
(631) 224-8510
Mailing address
1000 MONTAUK HWY, WEST ISLIP, NY 11795-4927
(631) 376-3000
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005308
BLUE CROSS
NY
05
—
03000328
—
NY
Enumeration date
12/06/2006
Last updated
06/17/2009
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