Provider Demographics
NPI:1922373380
Name:SAW MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:SAW MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRIUS
Authorized Official - Middle Name:LEONIDAS
Authorized Official - Last Name:MOUTSIAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:631-698-1552
Mailing Address - Street 1:400 HORSEBLOCK RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1252
Mailing Address - Country:US
Mailing Address - Phone:631-698-1552
Mailing Address - Fax:631-698-1553
Practice Address - Street 1:400 HORSEBLOCK RD
Practice Address - Street 2:SUITE E
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1252
Practice Address - Country:US
Practice Address - Phone:631-698-1552
Practice Address - Fax:631-698-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212315208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty