Provider Demographics
NPI:1982790192
Name:SUFFOLK OBGYN LLP
Entity Type:Organization
Organization Name:SUFFOLK OBGYN LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:SRETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-473-7171
Mailing Address - Street 1:118 NORTH COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-473-7171
Mailing Address - Fax:631-473-4605
Practice Address - Street 1:118 NORTH COUNTRY ROAD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-473-7171
Practice Address - Fax:631-473-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC3107OtherRAILROAD MEDICARE
NYW9L861Medicare PIN