Healthcare Provider Details

I. General information

NPI: 1942261128
Provider Name (Legal Business Name): SUFFOLK MRI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 W JERICHO TPKE
SMITHTOWN NY
11787-3203
US

IV. Provider business mailing address

987 W JERICHO TPKE
SMITHTOWN NY
11787-3203
US

V. Phone/Fax

Practice location:
  • Phone: 631-864-9100
  • Fax:
Mailing address:
  • Phone: 631-864-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIJEAN LECOMPTE
Title or Position: OFFICE MANAGER
Credential:
Phone: 631-864-9100