Provider Demographics
NPI:1568223923
Name:EASTERN SUFFOLK SPINE AND PAIN MEDICINE, PLLC
Entity Type:Organization
Organization Name:EASTERN SUFFOLK SPINE AND PAIN MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:PEARCE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-814-4146
Mailing Address - Street 1:3 FRANCES LN
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1125
Mailing Address - Country:US
Mailing Address - Phone:570-814-4146
Mailing Address - Fax:
Practice Address - Street 1:700 BOISSEAU AVE
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-2926
Practice Address - Country:US
Practice Address - Phone:631-477-5353
Practice Address - Fax:631-477-5891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty