Suffolk First Medical, P.c. | |
1235 Suffolk Ave Brentwood NY 11717-4511 | |
(631) 436-7770 | |
(631) 436-9003 |
Full Name | Suffolk First Medical, P.c. |
---|---|
Speciality | Internal Medicine |
Location | 1235 Suffolk Ave, Brentwood, New York |
Authorized Official Name and Position | In Ho Han (OWNER) |
Authorized Official Contact | 6314367770 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Suffolk First Medical, P.c. 1235 Suffolk Ave Brentwood NY 11717-4511 Ph: (631) 436-7770 | Suffolk First Medical, P.c. 1235 Suffolk Ave Brentwood NY 11717-4511 Ph: (631) 436-7770 |
NPI Number | 1851403398 |
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Provider Enumeration Date | 08/31/2006 |
Last Update Date | 05/04/2012 |
Medicare PECOS PAC ID | 4880640325 |
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Medicare Enrollment ID | O20050328000580 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851403398 | NPI | - | NPPES |
W14822 | Other | NY | MEDICARE PTIN |
01051692 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | In Ho Han |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1740330356 PECOS PAC ID: 0941253298 Enrollment ID: I20050225000730 |
Provider Name | Jiyoung Jeong Yang |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053895904 PECOS PAC ID: 4587080551 Enrollment ID: I20200820002943 |
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