Provider Demographics
NPI:1174702229
Name:NORTH SUFFOLK FAMILY MEDICAL CARE PLLC
Entity type:Organization
Organization Name:NORTH SUFFOLK FAMILY MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTDRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:SCHILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-331-1506
Mailing Address - Street 1:4 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4068
Mailing Address - Country:US
Mailing Address - Phone:631-331-1506
Mailing Address - Fax:631-331-1705
Practice Address - Street 1:4 TECHNOLOGY DR
Practice Address - Street 2:SUITE 210
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4068
Practice Address - Country:US
Practice Address - Phone:631-331-1506
Practice Address - Fax:631-331-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211383207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYY27577Medicare UPIN
NYWEV111Medicare PIN