MEDICARE: NORTH FORK SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1295365864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH FORK SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	700 BOISSEAU AVE
Second Line	:
City	:	SOUTHOLD
State	:	NY
Zip	:	11971-0727
Country	:	US
Telephone Number	:	631-477-5353
Fax Number	:	631-477-5891

Provider Business Practice Location Address
First Line	:	700 BOISSEAU AVE
Second Line	:
City	:	SOUTHOLD
State	:	NY
Zip	:	11971
Country	:	US
Telephone Number	:	631-477-5353
Fax Number	:	631-477-5891

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	FRANK J ADIPIETRO JR.
Credential	:	MD
Telephone Number	:	631-774-9292

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	01/23/2026

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