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General NPI Number Information
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NPI Number | 1558667907
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Entity Type | Organization
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Legal Business Name | EASTERN SUFFOLK CARDIOLOGY - STONY BROOK COMMUNITY MEDICAL PC
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Dates
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Enumeration Date | 02/02/2011
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 951 ROANOKE AVE
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City | RIVERHEAD
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State | NY
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Zip | 11901-2724
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Country | US
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Telephone | 631-727-7773
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Fax |
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Provider Business Mailing Address
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Address Line | 188 BELLE MEAD RD
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City | EAST SETAUKET
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State | NY
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Zip | 11733-3455
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Country | US
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Telephone | 631-638-4018
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. TODD R GRIFFIN
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Credential | MD
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Telephone | 631-638-4018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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