Provider Demographics
NPI:1669443123
Name:MEMORIAL SLOAN-KETTERING CANCER CENTER SUFFOLK AT HAUPPAUGE
Entity Type:Organization
Organization Name:MEMORIAL SLOAN-KETTERING CANCER CENTER SUFFOLK AT HAUPPAUGE
Other - Org Name:MSKCC SUFFOLK @ HAUPPAUGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDREOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-227-3751
Mailing Address - Street 1:633 3RD AVE
Mailing Address - Street 2:BOX 3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2948
Practice Address - Country:US
Practice Address - Phone:212-639-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W35101Medicare ID - Type Unspecified