Provider Demographics
NPI:1841683281
Name:PECONIC BAY MEDICAL SERVICES, P.C.
Entity type:Organization
Organization Name:PECONIC BAY MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-548-6470
Mailing Address - Street 1:185 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2121
Mailing Address - Country:US
Mailing Address - Phone:631-298-4479
Mailing Address - Fax:631-591-3047
Practice Address - Street 1:496 COUNTY ROAD 111
Practice Address - Street 2:BUILDING F
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-3383
Practice Address - Country:US
Practice Address - Phone:631-405-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty