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General NPI Number Information
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NPI Number | 1013242353
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN SURGICAL SERVICES, P.C.
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Dates
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Enumeration Date | 10/05/2009
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Last Update Date | 10/05/2009
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Provider Practice Location Address
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Address Line | 100 HOSPITAL RD
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-8809
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Country | US
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Telephone | 631-687-4022
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Fax |
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Provider Business Mailing Address
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Address Line | 100 HOSPITAL RD
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-8809
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Country | US
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Telephone | 631-687-4022
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CRAIG ORDWAY
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Credential | MD
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Telephone | 631-687-4022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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