=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619284650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUFFOLK AMBULATORY SURGERY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2010
-----------------------------------------------------
Last Update Date | 09/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 179 N BELLE MEAD RD SUITE 3
-----------------------------------------------------
City | EAST SETAUKET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11733-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-751-4400
-----------------------------------------------------
Fax | 631-689-2375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 179 N BELLE MEAD RD SUITE 3
-----------------------------------------------------
City | EAST SETAUKET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11733-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-751-4400
-----------------------------------------------------
Fax | 631-689-2375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. HILTON C ADLER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 631-751-4400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 050722
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------