Basic Information
| Provider Information | |||||||||
| NPI: | 1518264241 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH SUFFOLK CARDIOLOGY-STONY BROOK COMMUNITY MEDICAL, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 188 BELLE MEAD RD | ||||||||
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| City: | EAST SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117333455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316384018 | ||||||||
| FaxNumber: | 6316384065 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 RESEARCH WAY | ||||||||
| Address2: | |||||||||
| City: | EAST SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117336401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319412000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2011 | ||||||||
| LastUpdateDate: | 02/15/2011 | ||||||||
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| AuthorizedOfficialLastName: | GRIFFIN | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6316384018 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.