Provider Demographics
NPI:1518233287
Name:SUFFOLK PULMONARY AND SLEEP DISORDER, PC
Entity Type:Organization
Organization Name:SUFFOLK PULMONARY AND SLEEP DISORDER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:T
Authorized Official - Last Name:SAMEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-675-9393
Mailing Address - Street 1:3400 NESCONSET HWY
Mailing Address - Street 2:8 TECHNOLOGY DRIVE SUITE 103
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3327
Mailing Address - Country:US
Mailing Address - Phone:631-675-9393
Mailing Address - Fax:631-675-9391
Practice Address - Street 1:3400 NESCONSET HWY
Practice Address - Street 2:8 TECHNOLOGY DRIVE SUITE 103
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3327
Practice Address - Country:US
Practice Address - Phone:631-675-9393
Practice Address - Fax:631-675-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214732173F00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Multi-Specialty