Organization
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN BOURBIIN (PSYCHIATRIC SOCIAL WORKER)
(631) 854-2571
Entity
Organization
Contact information
Practice address
15 HORSEBLOCK PL, FARMINGVILLE, NY 11738-1204
(631) 543-3659
Mailing address
95 TULIPWOOD DR, COMMACK, NY 11725-5625
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
R0497521
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00354807
—
NY
Enumeration date
10/06/2006
Last updated
08/22/2020
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