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General NPI Number Information
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NPI Number | 1023574589
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Entity Type | Organization
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Legal Business Name | RIVERHEAD SURGERY, PC
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 4 TECHNOLOGY DRIVE SUITE 220
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City | EAST SETAUKET
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State | NY
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Zip | 11733-4085
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Country | US
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Telephone | 631-476-9296
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Fax | 631-476-9298
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Provider Business Mailing Address
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Address Line | 4 TECHNOLOGY DRIVE SUITE 220
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City | EAST SETAUKET
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State | NY
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Zip | 11733-4085
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Country | US
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Telephone | 631-476-9296
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Fax | 631-476-9298
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Authorized Official
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Title or Position | OWNER
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Name | HESHAM MAHMOUD ATWA
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Credential | M.D.
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Telephone | 631-476-9296
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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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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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