Provider Demographics
NPI:1811917578
Name:O'CONNOR, JOHN P (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4480 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933-1185
Mailing Address - Country:US
Mailing Address - Phone:631-208-2919
Mailing Address - Fax:631-208-0976
Practice Address - Street 1:NORTH SUFFOLK MEDICAL CARE, PC
Practice Address - Street 2:4480 MIDDLE COUNTRY RD
Practice Address - City:CALVERTON
Practice Address - State:NY
Practice Address - Zip Code:11933-1185
Practice Address - Country:US
Practice Address - Phone:631-208-2919
Practice Address - Fax:631-208-0976
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2025-01-08
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Provider Licenses
StateLicense IDTaxonomies
NY219769207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02234682Medicaid
NY02234682Medicaid
NYH32273Medicare UPIN