Provider Demographics
NPI:1477893113
Name:VASCULAR SURGERY ASSOCIATE OF SUFFOLK COUNTY, PLLC
Entity Type:Organization
Organization Name:VASCULAR SURGERY ASSOCIATE OF SUFFOLK COUNTY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:C
Authorized Official - Last Name:PULIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-654-2386
Mailing Address - Street 1:74 SOUTHAVEN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3746
Mailing Address - Country:US
Mailing Address - Phone:631-654-2386
Mailing Address - Fax:
Practice Address - Street 1:74 SOUTHAVEN AVE STE E
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3746
Practice Address - Country:US
Practice Address - Phone:631-654-2386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-17
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty