Organization
DEVELOPMENTAL DISABILITIES INSTITURE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNMARIE ROZA (CFO)
(631) 366-2960
Entity
Organization
Contact information
Practice address
75 LANDING MEADOW RD, SMITHTOWN, NY 11787-1124
(631) 366-5876
(631) 366-5893
Mailing address
99 HOLLYWOOD DR, SMITHTOWN, NY 11787-3135
(631) 366-5876
(631) 366-5893
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00630020
—
NY
Enumeration date
04/24/2008
Last updated
04/24/2008
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