Provider Demographics
NPI:1891886594
Name:MID-SUFFOLK PEDIATRIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MID-SUFFOLK PEDIATRIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-434-1770
Mailing Address - Street 1:1770 MOTOR PKWY
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5260
Mailing Address - Country:US
Mailing Address - Phone:631-434-1770
Mailing Address - Fax:631-232-3481
Practice Address - Street 1:1770 MOTOR PKWY
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5260
Practice Address - Country:US
Practice Address - Phone:631-434-1770
Practice Address - Fax:631-232-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty