Healthcare Provider Details

I. General information

NPI: 1740999085
Provider Name (Legal Business Name): SYOSSET SASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 EILEEN WAY SUITE 3
SYOSSET NY
11791-5302
US

IV. Provider business mailing address

SYOSSET SASC LLC 115 EILEEN WAY SUITE 3
SYOSSET NY
11791
US

V. Phone/Fax

Practice location:
  • Phone: 165-795-3033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM D CUNDIFF
Title or Position: COO
Credential:
Phone: 516-795-3033