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General NPI Number Information
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NPI Number | 1518233287
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Entity Type | Organization
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Legal Business Name | SUFFOLK PULMONARY AND SLEEP DISORDER, PC
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 3400 NESCONSET HWY 8 TECHNOLOGY DRIVE SUITE 103
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City | EAST SETAUKET
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State | NY
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Zip | 11733-3327
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Country | US
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Telephone | 631-675-9393
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Fax | 631-675-9391
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Provider Business Mailing Address
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Address Line | 3400 NESCONSET HWY 8 TECHNOLOGY DRIVE SUITE 103
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City | EAST SETAUKET
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State | NY
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Zip | 11733-3327
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Country | US
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Telephone | 631-675-9393
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Fax | 631-675-9391
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | MOHAMED T SAMEEN
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Credential | MD
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Telephone | 631-675-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173F00000X
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Taxonomy Name | Sleep Specialist (PhD)
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License Number | 214732
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 214732
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License Number State | NY
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