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Organization

CENTRAL SUFFOLK HOSPITAL

Active
Other names
Peconic Bay Medical Center
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MICHAEL O'DONNELL (SENIOR VP FOR FINACE AND CFO)
(631) 548-6060
Entity
Organization

Contact information

Practice address
1300 ROANOKE AVE, RIVERHEAD, NY 11901-2031
(631) 548-6000
Mailing address
1300 ROANOKE AVE, RIVERHEAD, NY 11901-2031
(631) 548-6000

Taxonomy

Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
5155000N
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00274328
NY
01
005225
BLUE CROSS DIALYSIS
NY
Enumeration date
07/27/2006
Last updated
04/20/2008
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