MEDICARE: SUFFOLK NEPHROLOGY ASSOCIATES, PC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1255501045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUFFOLK NEPHROLOGY ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	340 HOWELLS RD
Second Line	:	SUITE A
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5322
Country	:	US
Telephone Number	:	631-666-2808
Fax Number	:	631-666-3097

Provider Business Practice Location Address
First Line	:	340 HOWELLS RD
Second Line	:	SUITE A
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5322
Country	:	US
Telephone Number	:	631-666-2808
Fax Number	:	631-666-3097

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KATHERINE RAPP
Credential	:
Telephone Number	:	631-666-2808

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	03/07/2008

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