Organization
DEVELOPMEMTAL DISABILITIES INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOPHIA SAMUEL (CFO)
(631) 366-2960
Entity
Organization
Contact information
Practice address
98 BOURNE BLVD, SAYVILLE, NY 11782-3307
(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
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00971155
—
NY
Enumeration date
04/23/2008
Last updated
08/20/2015
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