Provider Demographics
NPI:1952624181
Name:MID-SUFFOLK NEUROSURGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:MID-SUFFOLK NEUROSURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIETER
Authorized Official - Middle Name:ARJEN
Authorized Official - Last Name:KEUSKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-265-2020
Mailing Address - Street 1:309 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2844
Mailing Address - Country:US
Mailing Address - Phone:631-265-2020
Mailing Address - Fax:631-265-2053
Practice Address - Street 1:309 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2844
Practice Address - Country:US
Practice Address - Phone:631-265-2020
Practice Address - Fax:631-265-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA99378Medicare UPIN