Provider Demographics
NPI:1104096049
Name:SOUTHWEST SUFFOLK MEDICAL, P.C.
Entity type:Organization
Organization Name:SOUTHWEST SUFFOLK MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF PHYSICIANS BILL
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANNIGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:631-224-8533
Mailing Address - Street 1:48 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1431
Mailing Address - Country:US
Mailing Address - Phone:631-862-3000
Mailing Address - Fax:631-224-8560
Practice Address - Street 1:48 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1431
Practice Address - Country:US
Practice Address - Phone:631-862-3000
Practice Address - Fax:631-224-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty