Provider Demographics
NPI:1114022084
Name:NORTH SUFFOLK MEDICAL CARE, PC
Entity type:Organization
Organization Name:NORTH SUFFOLK MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-208-2919
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:630-208-2919
Mailing Address - Fax:631-208-0976
Practice Address - Street 1:4480 MIDDLE COUNTRY RD
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH32273NMedicare UPIN
NYWEL101Medicare PIN