Healthcare Provider Details

I. General information

NPI: 1194826420
Provider Name (Legal Business Name): SUFFOLK ANESTHESIOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/06/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ROUTE 25A
SMITHTOWN NY
11787-1348
US

IV. Provider business mailing address

50 ROUTE 25A EMPLOYEE SERVICES BUILDING
SMITHTOWN NY
11787-1431
US

V. Phone/Fax

Practice location:
  • Phone: 631-862-3540
  • Fax: 631-862-3604
Mailing address:
  • Phone: 631-862-3540
  • Fax: 631-862-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYNN SCANZANI
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 631-862-3538