Provider Demographics
NPI:1407351646
Name:SAGAPONACK MEDICAL PC
Entity Type:Organization
Organization Name:SAGAPONACK MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-731-1099
Mailing Address - Street 1:3350 NOYAC RD
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-1908
Mailing Address - Country:US
Mailing Address - Phone:631-731-1099
Mailing Address - Fax:
Practice Address - Street 1:3350 NOYACK RD
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963
Practice Address - Country:US
Practice Address - Phone:631-731-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty