NPIMap

Organization Active NPI

CS Medical Associates, P.C.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Shirley, NY
National Provider Identifier
1346880960
Registry record updated Jan 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
CS MEDICAL ASSOCIATES, P.C.
Practice address
2 Coraci Blvd Ste 15
Shirley, NY 11967-4833
Phone
(631) 696-4357
Fax
(631) 846-8138
NPI assigned
Jan 11, 2020
Organization subpart
Yes
Parent organization
CS MEDICAL ASSOCIATES, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2020

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

Authorized official

Name
Tracey Wallace
Title
VP Ops
Phone
(631) 696-4357

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Addiction Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083A0300X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

2 Coraci Blvd Ste 15
Shirley, NY 11967-4833

Mailing address

100 Granny Rd Ste 1
Farmingville, NY 11738-2879
Phone (631) 696-4357

Other names 1

  • Victory Recovery Partners Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2178851CS Medical Associates PC2 Coraci Blvd - Suite 15, Shirley, NY 11967Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
CS Medical Associates PC8 organizations share this tax ID, including this one
Part of
CS Medical Associates PC

Other organizations with this tax ID 7

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

Locations

2 Coraci Blvd
Ste 15
Shirley, NY 11967
Phone (631) 315-2320

NPI Registry JSON

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

{
    "created_epoch": "1578700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578700800000",
    "number": "1346880960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GRANNY RD STE 1",
            "city": "FARMINGVILLE",
            "state": "NY",
            "postal_code": "117382879",
            "telephone_number": "631-696-4357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 CORACI BLVD STE 15",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119674833",
            "telephone_number": "631-696-4357",
            "fax_number": "631-846-8138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CS MEDICAL ASSOCIATES, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CS MEDICAL ASSOCIATES, P.C.",
        "enumeration_date": "2020-01-11",
        "last_updated": "2020-01-11",
        "certification_date": "2020-01-11",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "VP OPS",
        "authorized_official_telephone_number": "631-696-4357"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Victory Recovery Partners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shirley, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.