Basic Information
| Provider Information | |||||||||
| NPI: | 1205274081 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PECONIC BAY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5001 ROYAL PINES WAY | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945687761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103669227 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1300 ROANOKE AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119012031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315486446 | ||||||||
| FaxNumber: | 6317270772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2013 | ||||||||
| LastUpdateDate: | 06/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | NOORZAD | ||||||||
| AuthorizedOfficialFirstName: | JAVAID | ||||||||
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| AuthorizedOfficialTitleorPosition: | INTERN | ||||||||
| AuthorizedOfficialTelephone: | 5103669227 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.