Provider Demographics
NPI:1346426442
Name:SOUTH SUFFOLK ORTHOPEDIC SURGERY AND SPORTS MEDICINE P.C
Entity Type:Organization
Organization Name:SOUTH SUFFOLK ORTHOPEDIC SURGERY AND SPORTS MEDICINE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:A
Authorized Official - Last Name:RATZAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-376-4545
Mailing Address - Street 1:786 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4926
Mailing Address - Country:US
Mailing Address - Phone:631-376-4545
Mailing Address - Fax:
Practice Address - Street 1:786 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4926
Practice Address - Country:US
Practice Address - Phone:631-376-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWET481Medicare PIN