Central Suffolk Hospital

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

5155000N Issued in NY

Legal business name

CENTRAL SUFFOLK HOSPITAL

Doing business as

Peconic Bay Medical Center

Practice address

1300 Roanoke Ave
Riverhead, NY 11901-2031

Phone

(631) 548-6000

NPI assigned

Jul 27, 2006

Last updated

Apr 20, 2008By 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. Michael O'Donnell

Title

Senior VP for Finace and Cfo

Phone

(631) 548-6060

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Peconic Bay Medical Center Doing business as

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1710901160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 ROANOKE AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012031",
            "telephone_number": "631-548-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 ROANOKE AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012031",
            "telephone_number": "631-548-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL SUFFOLK HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "O'DONNELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "SENIOR VP FOR FINACE AND CFO",
        "authorized_official_telephone_number": "631-548-6060",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": "5155000N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00274328",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS DIALYSIS",
            "identifier": "005225",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peconic Bay Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Veronica Cea, M.S. CCC/SLP
• Alexis Marie Celentano, MS CCC-SLP
• Central Suffolk Hospital (Peconic Bay Medical Center Professional Group Practice)
• Central Suffolk Hospital (Peconic Bay Skilled Nursing Facility)
• Central Suffolk Hospital (Peconic Bay Medical Center)
• Central Suffolk Hospital (Peconic Bay Homehealth Services)
• Central Suffolk Hosptial (Peconic Bay Medical Center)
• Julian Cereghini, M.D.
• Sara Ann Cerrone, M.D.
• Agostino Cervone, M.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Riverhead, NY
• Providers in Riverhead, NY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.