Healthcare Provider Details

I. General information

NPI: 1093996209
Provider Name (Legal Business Name): SUFFOLK GYNECOLOGIC ONCOLOGY MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 POTTER BOULEVARD
BRIGHTWATERS NY
11718-1803
US

IV. Provider business mailing address

404 POTTER BOULEVARD
BRIGHTWATERS NY
11718-1803
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-0055
  • Fax: 631-376-0099
Mailing address:
  • Phone: 631-376-0055
  • Fax: 631-376-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN M SCHWARTZ
Title or Position: OWNER
Credential: MD
Phone: 631-376-0055