Healthcare Provider Details

I. General information

NPI: 1740514389
Provider Name (Legal Business Name): BROOKHAVEN SURGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MEDFORD AVE SUITE D
PATCHOGUE NY
11772-1229
US

IV. Provider business mailing address

55 MEDFORD AVE SUITE D
PATCHOGUE NY
11772-1229
US

V. Phone/Fax

Practice location:
  • Phone: 631-687-5400
  • Fax: 631-687-5430
Mailing address:
  • Phone: 631-687-5400
  • Fax: 631-687-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. CRAIG ORDWAY
Title or Position: OWNER
Credential: MD
Phone: 631-687-5400