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General NPI Number Information
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NPI Number | 1811235724
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Entity Type | Organization
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Legal Business Name | MEDICAL SERVICES OF SUFFOLK COUNTY PC
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Dates
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Enumeration Date | 01/28/2013
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 5800 RIDGE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1737
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Country | US
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Telephone | 215-483-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 7300 STATE HIGHWAY 121 STE 370-374
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City | MCKINNEY
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State | TX
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Zip | 75070-1987
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Country | US
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Telephone | 469-557-6183
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Fax | 469-640-6671
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT
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Name | JENNIFER BLAKEMAN
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Credential |
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Telephone | 469-557-6183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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