Organization
CENTRAL SUFFOLK HOSPITAL
Active
Other names
Peconic Bay Medical Center, Peconic Bay Homehealth Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELE L CUSACK (SENIOR VICE PRESIDENT & CFO)
(516) 321-6058
Entity
Organization
Contact information
Practice address
1300 ROANOKE AVE, RIVERHEAD, NY 11901-2031
(631) 548-6000
(631) 548-6397
Mailing address
1300 ROANOKE AVE, RIVERHEAD, NY 11901-2031
(631) 548-6000
(631) 548-6397
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
5155601
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000250-7
BLUE CROSS
NY
05
—
00274328
—
NY
05
—
03000300
—
NY
Enumeration date
05/25/2006
Last updated
12/09/2022
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