Healthcare Provider Details

I. General information

NPI: 1770513863
Provider Name (Legal Business Name): MITCHELL A SAUNDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 STONY BROOK RD BUILDING D SUITE 100
STONY BROOK NY
11790-2222
US

IV. Provider business mailing address

220 BELLE MEAD RD SUITE A
E. SETAUKET NY
11733
US

V. Phone/Fax

Practice location:
  • Phone: 631-941-2273
  • Fax: 631-941-2501
Mailing address:
  • Phone: 631-941-2273
  • Fax: 631-941-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number164946
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number164946
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: