Healthcare Provider Details

I. General information

NPI: 1801811161
Provider Name (Legal Business Name): SUZAN J BIGNAMI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MANOR PL
GREENPORT NY
11944
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-477-5427
  • Fax:
Mailing address:
  • Phone: 631-444-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009208
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: