Provider Demographics
NPI:1225084858
Name:SUFFOLK REHABILITATION MEDICINE, PLLC
Entity Type:Organization
Organization Name:SUFFOLK REHABILITATION MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-494-0914
Mailing Address - Street 1:679 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3831
Mailing Address - Country:US
Mailing Address - Phone:917-494-0914
Mailing Address - Fax:631-424-1241
Practice Address - Street 1:679 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3831
Practice Address - Country:US
Practice Address - Phone:917-494-0914
Practice Address - Fax:631-424-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222059208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDE8418OtherRAILROAD MEDICARE
NY896232Medicare PIN
NYI03360Medicare UPIN