Provider Demographics
NPI:1295952448
Name:SMITH HAVEN PEDIATRICS
Entity type:Organization
Organization Name:SMITH HAVEN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSULSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-863-6321
Mailing Address - Street 1:269 E MAIN ST
Mailing Address - Street 2:BUILDING D
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2832
Mailing Address - Country:US
Mailing Address - Phone:631-361-2121
Mailing Address - Fax:631-361-2153
Practice Address - Street 1:269 E MAIN ST
Practice Address - Street 2:BUILDING D
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2832
Practice Address - Country:US
Practice Address - Phone:631-361-2121
Practice Address - Fax:631-361-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1922084920OtherNPI
NY1487649182OtherNPI
NY1922084920OtherNPI