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General NPI Number Information
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NPI Number | 1174702229
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Entity Type | Organization
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Legal Business Name | NORTH SUFFOLK FAMILY MEDICAL CARE PLLC
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 05/09/2011
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Provider Practice Location Address
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Address Line | 4 TECHNOLOGY DR SUITE 210
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City | EAST SETAUKET
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State | NY
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Zip | 11733-4068
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Country | US
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Telephone | 631-331-1506
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Fax | 631-331-1705
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Provider Business Mailing Address
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Address Line | 4 TECHNOLOGY DR SUITE 210
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City | EAST SETAUKET
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State | NY
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Zip | 11733-4068
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Country | US
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Telephone | 631-331-1506
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Fax | 631-331-1705
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Authorized Official
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Title or Position | ADMINISTDRATOR
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Name | MS. DEBORAH SUSAN SCHILLER
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Credential |
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Telephone | 631-331-1506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 211383
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License Number State | NY
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