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General NPI Number Information
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NPI Number | 1174965727
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Entity Type | Organization
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Legal Business Name | SUFFOLK PRIMARY HEALTH, LLC
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 170 OLD COUNTRY RD
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City | RIVERHEAD
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State | NY
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Zip | 11901-2198
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Country | US
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Telephone | 631-208-4460
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Fax | 631-208-4462
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Provider Business Mailing Address
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Address Line | 5308 13TH AVE STE 334
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City | BROOKLYN
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State | NY
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Zip | 11219-5198
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Country | US
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Telephone | 631-208-4460
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Fax | 631-208-4462
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Authorized Official
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Title or Position | CEO
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Name | MR. MATISYAHU SWERDLOFF
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Credential |
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Telephone | 631-208-4460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 5155205R
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License Number State | NY
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