Provider Demographics
NPI:1205274081
Name:PECONIC BAY MEDICAL CENTER
Entity type:Organization
Organization Name:PECONIC BAY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVAID
Authorized Official - Middle Name:
Authorized Official - Last Name:NOORZAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:510-366-9227
Mailing Address - Street 1:5001 ROYAL PINES WAY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7761
Mailing Address - Country:US
Mailing Address - Phone:510-366-9227
Mailing Address - Fax:
Practice Address - Street 1:1300 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2031
Practice Address - Country:US
Practice Address - Phone:631-548-6446
Practice Address - Fax:631-727-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital