MEDICARE: SUFFOLK PRIMARY HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QP2300X	Primary Care Clinic/Center	5155205R	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5155205R	OTHER	NY	NYS DOH OPCERT
2	6361	OTHER	NY	NYS FACILITY ID

General Provider Information

NPI Number	:	1174965727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUFFOLK PRIMARY HEALTH, LLC

Provider Business Mailing Address
First Line	:	5308 13TH AVE STE 334
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5198
Country	:	US
Telephone Number	:	631-208-4460
Fax Number	:	631-208-4462

Provider Business Practice Location Address
First Line	:	170 OLD COUNTRY RD
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2198
Country	:	US
Telephone Number	:	631-208-4460
Fax Number	:	631-208-4462

Authorized Official
Title or Position	:	CEO
Name	:	MR. MATISYAHU SWERDLOFF
Credential	:
Telephone Number	:	631-208-4460

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	10/24/2025

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