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General NPI Number Information
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NPI Number | 1477893113
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Entity Type | Organization
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Legal Business Name | VASCULAR SURGERY ASSOCIATE OF SUFFOLK COUNTY, PLLC
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Dates
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Enumeration Date | 02/17/2013
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 33 MEDFORD AVE STE A
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City | PATCHOGUE
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State | NY
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Zip | 11772-1222
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Country | US
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Telephone | 631-569-5410
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Fax | 631-569-5413
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Provider Business Mailing Address
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Address Line | 33 MEDFORD AVE STE A
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City | PATCHOGUE
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State | NY
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Zip | 11772-1222
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Country | US
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Telephone | 631-569-5410
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Fax | 631-569-5413
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Authorized Official
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Title or Position | MANAGER
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Name | DANIELLE COWAN
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Credential |
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Telephone | 631-569-5410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease 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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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