Healthcare Provider Details

I. General information

NPI: 1811917578
Provider Name (Legal Business Name): JOHN P O'CONNOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/08/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTH SUFFOLK MEDICAL CARE, PC 4480 MIDDLE COUNTRY RD
CALVERTON NY
11933-1185
US

IV. Provider business mailing address

4480 MIDDLE COUNTRY RD
CALVERTON NY
11933-1185
US

V. Phone/Fax

Practice location:
  • Phone: 631-208-2919
  • Fax: 631-208-0976
Mailing address:
  • Phone: 631-208-2919
  • Fax: 631-208-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number219769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: