Provider Demographics
NPI:1851403398
Name:SUFFOLK FIRST MEDICAL, P.C.
Entity Type:Organization
Organization Name:SUFFOLK FIRST MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IN
Authorized Official - Middle Name:HO
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-436-7770
Mailing Address - Street 1:1235 SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4511
Mailing Address - Country:US
Mailing Address - Phone:631-436-7770
Mailing Address - Fax:631-436-9003
Practice Address - Street 1:1235 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4511
Practice Address - Country:US
Practice Address - Phone:631-436-7770
Practice Address - Fax:631-436-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW14822OtherMEDICARE PTIN
NY01051692Medicaid
NYW14822OtherMEDICARE PTIN