Provider Demographics
NPI:1740514389
Name:BROOKHAVEN SURGICAL SERVICES, P.C.
Entity type:Organization
Organization Name:BROOKHAVEN SURGICAL SERVICES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-687-5400
Mailing Address - Street 1:55 MEDFORD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1229
Mailing Address - Country:US
Mailing Address - Phone:631-687-5400
Mailing Address - Fax:631-687-5430
Practice Address - Street 1:55 MEDFORD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1229
Practice Address - Country:US
Practice Address - Phone:631-687-5400
Practice Address - Fax:631-687-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty