Healthcare Provider Details

I. General information

NPI: 1720991680
Provider Name (Legal Business Name): EAST END SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 WADING RIVER ROAD UNIT 2A
MANORVILLE NY
11949
US

IV. Provider business mailing address

287 WADING RIVER ROAD UNIT 2A
MANORVILLE NY
11949
US

V. Phone/Fax

Practice location:
  • Phone: 631-591-3000
  • Fax: 631-591-1734
Mailing address:
  • Phone: 631-591-3000
  • Fax: 631-591-1734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK CORONEL
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 631-591-3000