| Suffolk Pediatric, Pc | |
|
45 W Suffolk Ave 2nd Floor Central Islip NY 11722-2156 | |
| (631) 582-2228 | |
| (631) 582-4881 |
| Full Name | Suffolk Pediatric, Pc |
|---|---|
| Speciality | Pediatrics |
| Location | 45 W Suffolk Ave, Central Islip, New York |
| Authorized Official Name and Position | David Efrain Sanchez (PRESIDENT) |
| Authorized Official Contact | 6315822228 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Suffolk Pediatric, Pc 45 W Suffolk Ave 2nd Floor Central Islip NY 11722-2156 Ph: (631) 582-2228 | Suffolk Pediatric, Pc 45 W Suffolk Ave 2nd Floor Central Islip NY 11722-2156 Ph: (631) 582-2228 |
| NPI Number | 1427355775 |
|---|---|
| Provider Enumeration Date | 02/23/2011 |
| Last Update Date | 02/23/2011 |
| Medicare PECOS PAC ID | 0648454116 |
|---|---|
| Medicare Enrollment ID | O20110407000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427355775 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 258769-1 (New York) | Secondary |
| 208000000X | Pediatrics | 215692-1 (New York) | Primary |
| Provider Name | Marie C Jacques |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457488082 PECOS PAC ID: 1850383712 Enrollment ID: I20040331001162 |
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