Provider Demographics
NPI:1871869305
Name:SUFFOLK ANESTHESIA SERVICES PLLC
Entity type:Organization
Organization Name:SUFFOLK ANESTHESIA SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-849-1050
Mailing Address - Street 1:PO BOX 2448
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-2448
Mailing Address - Country:US
Mailing Address - Phone:631-849-1050
Mailing Address - Fax:803-520-4125
Practice Address - Street 1:471 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4414
Practice Address - Country:US
Practice Address - Phone:631-849-1050
Practice Address - Fax:631-849-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100085823OtherMEDICARE PTAN