| Boces - School Based Program | |
|
350 Martha Avenue Bellport NY 11713 | |
| (631) 854-1200 | |
| Not Available |
| Full Name | Boces - School Based Program |
|---|---|
| Speciality | Clinic/center - Student Health |
| Location | 350 Martha Avenue, Bellport, New York |
| Authorized Official Name and Position | David Graham (ACTING COMMISSIONER) |
| Authorized Official Contact | 6318533000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boces - School Based Program 225 Rabro Dr East Hauppauge NY 11788 Ph: (631) 853-4026 | Boces - School Based Program 350 Martha Avenue Bellport NY 11713 Ph: (631) 854-1200 |
| NPI Number | 1831265677 |
|---|---|
| Provider Enumeration Date | 11/24/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831265677 | NPI | - | NPPES |
| 00473170 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QS1000X | Clinic/center - Student Health | 5155200R (New York) | Primary |
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School Based Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 350 Martha Ave, Bellport, NY 11713 Phone: 631-286-6544 Fax: 631-286-7128 |