Provider Demographics
NPI:1316121973
Name:BROOKHAVEN SURGICAL SERVICES PC
Entity type:Organization
Organization Name:BROOKHAVEN SURGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-654-7175
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-8809
Mailing Address - Country:US
Mailing Address - Phone:631-475-8846
Mailing Address - Fax:631-475-8800
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:SUITE 106
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8809
Practice Address - Country:US
Practice Address - Phone:631-475-8846
Practice Address - Fax:631-475-8800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-19
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000010Medicare PIN