NPIMap

Organization Active NPI

County of Suffolk

Doing business as Martin Luther King Jr Family Health Center

  • Clinic/Center
  • Wyandanch, NY
National Provider Identifier
1275637480
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
COUNTY OF SUFFOLK
Doing business as
Martin Luther King Jr Family Health Center
Practice address
1556 Straight Path
Wyandanch, NY 11798-3213
Phone
(631) 854-1700
Fax
(631) 854-1783
NPI assigned
Sep 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Authorized official

Name
Dr. James L Tomarken, MSW,MPH,MBA,FRCPC,FA
Title
Commissioner
Phone
(631) 854-0100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1556 Straight Path
Wyandanch, NY 11798-3213

Mailing address

3500 Sunrise Hwy, Suite 124
P.O. Box 9006
Great River, NY 11739-9006
Phone (631) 854-0000

Other identifiers 1

IdentifierTypeStateIssuer
03003601MedicaidNY

Other names 1

  • MARTIN LUTHER KING JR FAMILY HEALTH CENTER Doing business as

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1350432000000",
    "number": "1275637480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 SUNRISE HWY, SUITE 124",
            "address_2": "P.O. BOX 9006",
            "city": "GREAT RIVER",
            "state": "NY",
            "postal_code": "117399006",
            "telephone_number": "631-854-0000",
            "fax_number": "631-854-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1556 STRAIGHT PATH",
            "city": "WYANDANCH",
            "state": "NY",
            "postal_code": "117983213",
            "telephone_number": "631-854-1700",
            "fax_number": "631-854-1783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SUFFOLK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2012-10-17",
        "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.",
        "authorized_official_credential": "MSW,MPH,MBA,FRCPC,FA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03003601",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARTIN LUTHER KING JR FAMILY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wyandanch, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.