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NPI Code Detail

MEDICARE: EASTERN MEDICAL CARE OF SUFFOLK COUNTY, P.C.

MEDICARE: EASTERN MEDICAL CARE OF SUFFOLK COUNTY, P.C.
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
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1851570196
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTERN MEDICAL CARE OF SUFFOLK COUNTY, P.C.
Provider Business Mailing Address
First Line : 215 HALLOCK RD STE 3A
Second Line :
City : STONY BROOK
State : NY
Zip : 11790-3077
Country : US
Telephone Number : 631-689-8889
Fax Number : 631-689-8882
Provider Business Practice Location Address
First Line : 215 HALLOCK RD STE 3A
Second Line :
City : STONY BROOK
State : NY
Zip : 11790-3077
Country : US
Telephone Number : 631-689-8889
Fax Number : 631-689-8882
Authorized Official
Title or Position : OFFICE MANAGER
Name : SANDY SOON-LIN
Credential :
Telephone Number : 631-689-8889
Provider Enumeration Date : 11/02/2007
Last Update Date : 11/02/2007

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Directions to “EASTERN MEDICAL CARE OF SUFFOLK COUNTY, P.C. ” Practice Location

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