NPIMap

Organization Active NPI

Suffolk County Dept of Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Riverhead, NY
National Provider Identifier
1104920313
Registry record updated Oct 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
6919109A Issued in NY
Legal business name
SUFFOLK COUNTY DEPT OF HEALTH SERVICES
Practice address
300 Center Dr
Riverhead, NY 11901-3393
Phone
(631) 852-1440
Fax
(631) 852-1448
NPI assigned
Sep 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. James L Tomarken
Title
Commissioner
Phone
(631) 854-0100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 6919109A NY Primary

Addresses

Primary practice location

300 Center Dr
Riverhead, NY 11901-3393

Mailing address

3500 Sunrise Hwy
Suite 124, PO Box 9006
Great River, NY 11739-1001
Phone (631) 854-0196

Other identifiers 1

IdentifierTypeStateIssuer
00688179MedicaidNY

Other names 1

  • Riverhead Mental Health Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040317000525 NY Part B Supplier - Clinic/Group Practice 2264344316 Receives reassigned benefits from 17 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Farmingville, NY; Riverhead, NY; Yaphank, NY

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Anjumon a Amin17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1104920313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 SUNRISE HWY",
            "address_2": "SUITE 124, PO BOX 9006",
            "city": "GREAT RIVER",
            "state": "NY",
            "postal_code": "117391001",
            "telephone_number": "631-854-0196",
            "fax_number": "631-854-0198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CENTER DR",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119013393",
            "telephone_number": "631-852-1440",
            "fax_number": "631-852-1448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUFFOLK COUNTY DEPT OF HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2012-10-22",
        "status": "A",
        "authorized_official_last_name": "TOMARKEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "COMMISSIONER",
        "authorized_official_telephone_number": "631-854-0100",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NY",
            "license": "6919109A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00688179",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverhead Mental Health Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Riverhead, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.