Provider Demographics
NPI:1447414370
Name:NORTH SUFFOLK SURGICAL ASSOC
Entity Type:Organization
Organization Name:NORTH SUFFOLK SURGICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-474-0707
Mailing Address - Street 1:333 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8556
Mailing Address - Country:US
Mailing Address - Phone:631-474-0707
Mailing Address - Fax:631-474-4034
Practice Address - Street 1:625 BELLE TERRE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2316
Practice Address - Country:US
Practice Address - Phone:631-474-0707
Practice Address - Fax:631-474-4034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133133174400000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty