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General NPI Number Information
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NPI Number | 1477767465
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Entity Type | Organization
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Legal Business Name | EASTERN SUFFOLK PULMONOLOGY,PC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 1149 OLD COUNTRY RD SUITE C-2
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City | RIVERHEAD
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State | NY
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Zip | 11901-2057
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Country | US
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Telephone | 631-369-7660
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Fax | 631-369-7688
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Provider Business Mailing Address
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Address Line | 1149 OLD COUNTRY RD SUITE C-2
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City | RIVERHEAD
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State | NY
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Zip | 11901-2057
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Country | US
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Telephone | 631-369-7660
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Fax | 631-369-7688
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAJESH C PATEL
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Credential | MD
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Telephone | 631-369-7660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 194902
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License Number State | NY
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