Provider Demographics
NPI:1720317662
Name:TOP TIER MEDICAL BREAST SPECIALIST PC
Entity Type:Organization
Organization Name:TOP TIER MEDICAL BREAST SPECIALIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-930-9422
Mailing Address - Street 1:150 E SUNRISE HWY
Mailing Address - Street 2:208
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2598
Mailing Address - Country:US
Mailing Address - Phone:631-870-8721
Mailing Address - Fax:631-870-8722
Practice Address - Street 1:150 E SUNRISE HWY
Practice Address - Street 2:208
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2598
Practice Address - Country:US
Practice Address - Phone:631-870-8721
Practice Address - Fax:631-870-8722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235438208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty