Healthcare Provider Details

I. General information

NPI: 1114022084
Provider Name (Legal Business Name): NORTH SUFFOLK MEDICAL CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 02/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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: 630-208-2919
  • Fax: 631-208-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN P O'CONNOR
Title or Position: OWNER
Credential: MD
Phone: 631-208-2919