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General NPI Number Information
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NPI Number | 1508234113
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Entity Type | Organization
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Legal Business Name | SUFFOLK DERMATOLOGY PC
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 500 PORTION RD STE 12
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City | RONKONKOMA
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State | NY
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Zip | 11779-4587
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Country | US
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Telephone | 631-648-0101
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Fax | 631-648-0191
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Provider Business Mailing Address
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Address Line | 500 PORTION RD STE 11
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City | RONKONKOMA
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State | NY
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Zip | 11779-4587
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Country | US
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Telephone | 631-648-0101
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Fax | 631-648-0191
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID I SILVERSTEIN
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Credential | M.D.
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Telephone | 631-648-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 256750
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License Number State | NY
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