Organization
SUFFOLK SURGICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK SHAYOWITZ (MANAGER)
(631) 475-1013
Entity
Organization
Contact information
Practice address
250 PATCHOGUE YAPHANK RD, SUITE #17, EAST PATCHOGUE, NY 11772-4800
(631) 475-1013
(631) 475-1092
Mailing address
250 PATCHOGUE YAPHANK RD, SUITE #17, EAST PATCHOGUE, NY 11772-4800
(631) 475-1013
(631) 475-1092
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02905686
—
NY
Enumeration date
12/29/2006
Last updated
01/11/2012
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