Healthcare Provider Details

I. General information

NPI: 1275134314
Provider Name (Legal Business Name): NORTH FORK SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BOISSEAU AVE
SOUTHOLD NY
11971-2926
US

IV. Provider business mailing address

PO BOX 727
SOUTHOLD NY
11971-0727
US

V. Phone/Fax

Practice location:
  • Phone: 631-477-5353
  • Fax: 631-477-2891
Mailing address:
  • Phone: 631-774-9292
  • Fax: 631-477-5891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANK J ADIPIETRO JR.
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 631-477-5353