Organization
GREAT SOUTH BAY SURGICAL ASSOCIATES AND VASCULAR LAB, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DENISE M. BELLO (OFFICE MANAGER)
(631) 321-6801
Entity
Organization
Contact information
Practice address
580 UNION BLVD, WEST ISLIP, NY 11795-3105
(631) 321-6801
(631) 321-3869
Mailing address
580 UNION BLVD, WEST ISLIP, NY 11795-3105
(631) 321-6801
(631) 321-3869
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0127X
Trauma Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
01/31/2007
Last updated
11/13/2009
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