Healthcare Provider Details

I. General information

NPI: 1215549803
Provider Name (Legal Business Name): NASSAU SUFFOLK SURGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MAIN ST STE 6
HUNTINGTON NY
11743-2845
US

IV. Provider business mailing address

110 E MAIN ST STE 6
HUNTINGTON NY
11743-2845
US

V. Phone/Fax

Practice location:
  • Phone: 631-424-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES E. THOMPSON III
Title or Position: CO-OWNER
Credential: MD
Phone: 404-396-9039