Provider Demographics
NPI:1689731317
Name:SUFFOLK CHEST PHYSICIANS, LLP
Entity Type:Organization
Organization Name:SUFFOLK CHEST PHYSICIANS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MULRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:631-654-4577
Mailing Address - Street 1:285 SILLS RD
Mailing Address - Street 2:BUILDING 7, SUITE B
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:631-654-4577
Mailing Address - Fax:631-654-3391
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:BUILDING 7, SUITE B
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-654-4577
Practice Address - Fax:631-654-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02556187Medicaid
NY02556187Medicaid