Provider Demographics
NPI:1467087627
Name:SJ SURGERY OF NY, PC
Entity Type:Organization
Organization Name:SJ SURGERY OF NY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANG
Authorized Official - Middle Name:H
Authorized Official - Last Name:JHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-568-8540
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-0512
Mailing Address - Country:US
Mailing Address - Phone:917-568-8540
Mailing Address - Fax:
Practice Address - Street 1:1111 MONTAUK HWY STE 2-2
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4910
Practice Address - Country:US
Practice Address - Phone:917-568-8540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty