1619284650 NPI number — SUFFOLK AMBULATORY SURGERY, PLLC

Table of content: JONASIA JONES RBT (NPI 1508623851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619284650 NPI number — SUFFOLK AMBULATORY SURGERY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUFFOLK AMBULATORY SURGERY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619284650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
179 N BELLE MEAD RD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
EAST SETAUKET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11733-3528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-751-4400
Provider Business Mailing Address Fax Number:
631-689-2375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 N BELLE MEAD RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
EAST SETAUKET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11733-3528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-751-4400
Provider Business Practice Location Address Fax Number:
631-689-2375
Provider Enumeration Date:
09/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ADLER
Authorized Official First Name:
HILTON
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
631-751-4400

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  050722 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 050722 . This is a "NYS OFFICE OF PROFESSIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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