Provider Demographics
NPI:1942484423
Name:SUFFOLK ORTHOPAEDIC ASSOCIATES PC
Entity Type:Organization
Organization Name:SUFFOLK ORTHOPAEDIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:TABERSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-665-8790
Mailing Address - Street 1:375 E MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8418
Mailing Address - Country:US
Mailing Address - Phone:631-665-8790
Mailing Address - Fax:631-665-1581
Practice Address - Street 1:375 E MAIN ST
Practice Address - Street 2:STE 1
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8418
Practice Address - Country:US
Practice Address - Phone:631-665-8790
Practice Address - Fax:631-665-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty