Basic Information
| Provider Information | |||||||||
| NPI: | 1558667907 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTERN SUFFOLK CARDIOLOGY - STONY BROOK COMMUNITY MEDICAL PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 188 BELLE MEAD RD | ||||||||
| Address2: | |||||||||
| City: | EAST SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117333455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316384018 | ||||||||
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| Practice Location | |||||||||
| Address1: | 951 ROANOKE AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119012724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317277773 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2011 | ||||||||
| LastUpdateDate: | 02/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | GRIFFIN | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| 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 | 207RI0011X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.