Provider Demographics
NPI:1013316785
Name:SOUTHAMPTON PRIMACARE MEDICAL PC
Entity Type:Organization
Organization Name:SOUTHAMPTON PRIMACARE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVATORE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-283-0957
Mailing Address - Street 1:425 COUNTY ROAD 39A
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5277
Mailing Address - Country:US
Mailing Address - Phone:631-283-0957
Mailing Address - Fax:
Practice Address - Street 1:425 COUNTY ROAD 39A
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5277
Practice Address - Country:US
Practice Address - Phone:631-283-0957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182616174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty