Suffolk Icm Program

NPI #1184962177 in Brentwood, New York

Provider Information

NPI Number: 1184962177
Entity Type: Organization
Organization Name: Suffolk Icm Program
Primary Specialty: Psychiatric Hospital
Enumeration Date: Jan 25, 2013
Last Updated: Jan 25, 2013

Practice Location

Address: 998 CROOKED HILL RD
City: Brentwood
State: New York
ZIP Code: 11717-1019
Phone: (631) 761-4181

Authorized Official

Name: MR. JOSEPH JOHN CASEY, BA,BSN,RN
Title: ICM SUPERVISOR
Phone: (631) 761-4181

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychiatric Hospital	283Q00000X	Primary

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