- Enrollment id
- O20120410000228
- Enrollment state
- NY
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1932155678
- Multiple npi flag
- N
- Ccn
- 337400
- Associate id
- 4981508082
- Organization name
- CENTRAL SUFFOLK HOSPITAL
- Doing business as name
- PECONIC BAY MEDICAL CENTER
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 244 OLD COUNTRY RD
- Address line 2
- STE 2
- City
- RIVERHEAD
- State
- NY
- Zip code
- 119012126
- Practice location type
- HHA BRANCH