Suffolk Center Receiver LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

5123300N Issued in NY

Legal business name

SUFFOLK CENTER RECEIVER LLC

Doing business as

Suffolk Center for Rehabilitation and Nursing

Practice address

25 Schoenfeld Blvd
Pathchogue, NY 11772

Phone

(631) 289-7700

Fax

(631) 289-7726

NPI assigned

Dec 15, 2006

Last updated

Dec 3, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Paul Konstam

Title

Administrator

Phone

(631) 289-7700

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Suffolk Center for Rehabilitation and Nursing Doing business as

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196640000000",
    "number": "1396807244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 SCHOENFELD BLVD",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "11772",
            "telephone_number": "631-289-7700",
            "fax_number": "631-289-7726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 SCHOENFELD BLVD",
            "city": "PATHCHOGUE",
            "state": "NY",
            "postal_code": "11772",
            "telephone_number": "631-289-7700",
            "fax_number": "631-289-7726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUFFOLK CENTER RECEIVER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2007-12-03",
        "status": "A",
        "authorized_official_last_name": "KONSTAM",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "631-289-7700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "NY",
            "license": "5123300N",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "5123300N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00309733",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suffolk Center for Rehabilitation and Nursing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.