NPIMap

Organization Active NPI

Developmental Disabilities Institute

  • Intellectual Disabilities Intermediate Care Facility
  • Smithtown, NY
National Provider Identifier
1487820460
Registry record updated Aug 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
DEVELOPMENTAL DISABILITIES INSTITUTE
Practice address
99 Hollywood Dr
Smithtown, NY 11787-3135
Phone
(631) 366-5876
Fax
(631) 366-5893
NPI assigned
Apr 30, 2008
Last updated
Aug 17, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2015

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

Authorized official

Name
Sophia Samuel
Title
Cfo
Phone
(631) 366-2960

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

99 Hollywood Dr
Smithtown, NY 11787-3135

Mailing address

99 Hollywood Dr
Smithtown, NY 11787-3135
Phone (631) 366-5876

Other identifiers 1

IdentifierTypeStateIssuer
01102776MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Developmental Disabilities Institute17 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

Locations

99 Hollywood Dr
Smithtown, NY 11787
Phone (631) 366-2900

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439769600000",
    "number": "1487820460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 HOLLYWOOD DR",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117873135",
            "telephone_number": "631-366-5876",
            "fax_number": "631-366-5893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 HOLLYWOOD DR",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117873135",
            "telephone_number": "631-366-5876",
            "fax_number": "631-366-5893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVELOPMENTAL DISABILITIES INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2015-08-17",
        "status": "A",
        "authorized_official_last_name": "SAMUEL",
        "authorized_official_first_name": "SOPHIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "631-366-2960"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01102776",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithtown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; 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.