Provider Demographics
NPI:1497166615
Name:SUFFOLK SPINE AND REHABILITATION MEDICINE
Entity Type:Organization
Organization Name:SUFFOLK SPINE AND REHABILITATION MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:STERLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-343-7700
Mailing Address - Street 1:1056 JERICHO TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1348
Mailing Address - Country:US
Mailing Address - Phone:631-434-7700
Mailing Address - Fax:631-267-4141
Practice Address - Street 1:1056 JERICHO TURNPIKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1348
Practice Address - Country:US
Practice Address - Phone:631-434-7700
Practice Address - Fax:631-267-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty