Provider Demographics
NPI:1255501045
Name:SUFFOLK NEPHROLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:SUFFOLK NEPHROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-666-2808
Mailing Address - Street 1:340 HOWELLS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5322
Mailing Address - Country:US
Mailing Address - Phone:631-666-2808
Mailing Address - Fax:631-666-3097
Practice Address - Street 1:340 HOWELLS RD
Practice Address - Street 2:SUITE A
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5322
Practice Address - Country:US
Practice Address - Phone:631-666-2808
Practice Address - Fax:631-666-3097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty