Provider Demographics
NPI:1407825367
Name:SUFFOLK OPHTHALMOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:SUFFOLK OPHTHALMOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:LEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-665-1330
Mailing Address - Street 1:375 E MAIN ST
Mailing Address - Street 2:STE 24
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-665-1330
Mailing Address - Fax:631-665-1363
Practice Address - Street 1:375 E MAIN ST
Practice Address - Street 2:STE 24
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-665-1330
Practice Address - Fax:631-665-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty