Provider Demographics
NPI:1023574589
Name:RIVERHEAD SURGERY, PC
Entity Type:Organization
Organization Name:RIVERHEAD SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HESHAM
Authorized Official - Middle Name:MAHMOUD
Authorized Official - Last Name:ATWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-476-9296
Mailing Address - Street 1:4 TECHNOLOGY DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4085
Mailing Address - Country:US
Mailing Address - Phone:631-476-9296
Mailing Address - Fax:631-476-9298
Practice Address - Street 1:4 TECHNOLOGY DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4085
Practice Address - Country:US
Practice Address - Phone:631-476-9296
Practice Address - Fax:631-476-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty