Healthcare Provider Details

I. General information

NPI: 1023315512
Provider Name (Legal Business Name): SURGICAL SPECIALISTS OF GREATER NY LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BERRY HILL RD
OYSTER BAY NY
11771-3515
US

IV. Provider business mailing address

40 BERRY HILL RD
OYSTER BAY NY
11771-3515
US

V. Phone/Fax

Practice location:
  • Phone: 718-626-0707
  • Fax: 718-545-0333
Mailing address:
  • Phone: 718-626-0707
  • Fax: 718-545-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PANAGIOTIS A MANOLAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-626-0707