Provider Demographics
NPI:1477767465
Name:EASTERN SUFFOLK PULMONOLOGY,PC
Entity Type:Organization
Organization Name:EASTERN SUFFOLK PULMONOLOGY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-369-7660
Mailing Address - Street 1:1149 OLD COUNTRY RD
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2057
Mailing Address - Country:US
Mailing Address - Phone:631-369-7660
Mailing Address - Fax:631-369-7688
Practice Address - Street 1:1149 OLD COUNTRY RD
Practice Address - Street 2:SUITE C-2
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2057
Practice Address - Country:US
Practice Address - Phone:631-369-7660
Practice Address - Fax:631-369-7688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW31291Medicare PIN
NY33N011Medicare PIN