Active NPI
Good Samaritan University Hospital- St. Charles Campus
- Psychologist
- Port Jefferson, NY
National Provider Identifier
1275447716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Legal business name
- GOOD SAMARITAN UNIVERSITY HOSPITAL- ST. CHARLES CAMPUS
- Practice address
- 200 Belle Terre Rd
Port Jefferson, NY 11777-1928 - Phone
- (631) 474-6000
- NPI assigned
- Oct 1, 2026
- Last updated
- Oct 1, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lorraine Hummel
- Title
- VP, Physician Enterprise Financial
- Phone
- (631) 465-6001
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | NU | Primary | |
| Internal Medicine Physician | 207R00000X | NU | ||
| Obstetrics & Gynecology Physician | 207V00000X | NU | ||
| Pediatrics Physician | 208000000X | NU | ||
| Physical Medicine & Rehabilitation Physician | 208100000X | NU | ||
| Neurology Physician | 2084N0400X | NU |
Addresses
Primary practice location
200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Mailing address
PO Box 95000-6540
Philadelphia, PA 19195-0001
Phone (631) 465-6121
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790812800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1790812800000",
"number": "1275447716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 95000-6540",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191950001",
"telephone_number": "631-465-6121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 BELLE TERRE RD",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771928",
"telephone_number": "631-474-6000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GOOD SAMARITAN UNIVERSITY HOSPITAL- ST. CHARLES CAMPUS",
"organizational_subpart": "NO",
"enumeration_date": "2026-10-01",
"last_updated": "2026-10-01",
"certification_date": "2026-10-01",
"status": "A",
"authorized_official_last_name": "HUMMEL",
"authorized_official_first_name": "LORRAINE",
"authorized_official_title_or_position": "VP, PHYSICIAN ENTERPRISE FINANCIAL",
"authorized_official_telephone_number": "631-465-6001"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.