Active NPI
County of Suffolk
- Methadone Clinic
- Hauppauge, NY
National Provider Identifier
1669574547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Methadone Clinic
- License
- 040710508
- Legal business name
- COUNTY OF SUFFOLK
- Practice address
- 200 Wireless Blvd
Hauppauge, NY 11788-3974 - Phone
- (631) 853-7373
- NPI assigned
- Sep 2, 2006
- 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
- Mr. Gregson Pigott
- Title
- Commissioner
- Phone
- (631) 854-0100
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Methadone Clinic | 261QM2800X | 040710508 | NY | Primary |
Addresses
Primary practice location
200 Wireless Blvd
Hauppauge, NY 11788-3974
Mailing address
3500 Sunrise Hwy
Suite 124, PO Box 9006
Great River, NY 11739-1001
Phone (631) 854-0100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03003665 | Medicaid | NY |
Other names 1
- METHADONE MAINTENANCE CLINIC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260127002948 | NY | Part A Provider - Opioid Treatment Program (Otp) | 2264344316 |
2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Hauppauge, NY; Riverhead, NY; Smithtown, NY |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1594339200000",
"number": "1669574547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 SUNRISE HWY",
"address_2": "SUITE 124, PO BOX 9006",
"city": "GREAT RIVER",
"state": "NY",
"postal_code": "117391001",
"telephone_number": "631-854-0100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 WIRELESS BLVD",
"city": "HAUPPAUGE",
"state": "NY",
"postal_code": "117883974",
"telephone_number": "631-853-7373"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COUNTY OF SUFFOLK",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-02",
"last_updated": "2020-07-10",
"certification_date": "2020-07-10",
"status": "A",
"authorized_official_last_name": "PIGOTT",
"authorized_official_first_name": "GREGSON",
"authorized_official_title_or_position": "COMMISSIONER",
"authorized_official_telephone_number": "631-854-0100",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QM2800X",
"taxonomy_group": "",
"desc": "Clinic/Center, Methadone",
"state": "NY",
"license": "040710508",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03003665",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "METHADONE MAINTENANCE CLINIC",
"code": "5",
"type": "Other Name"
},
{
"organization_name": "METHADONE MAINTENANCE CLINIC",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Hauppauge, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; 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.