Suffolk Breast Imaging PC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

51017552 Issued in NY

Legal business name

SUFFOLK BREAST IMAGING PC

Practice address

2780 Middle Country Rd
Suite 210
Lake Grove, NY 11755-2124

Phone

(631) 588-4500

Fax

(631) 588-4595

NPI assigned

Aug 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alexandra B Perkins, M.D.NPI 1033169404

Title

Medical Director

Phone

(631) 588-4500

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alexandra B Perkins, M.D.

  • Diagnostic Radiology Physician
  • Lake Grove, NY
  • NPI 1033169404
  Medicare reassignment NPD Authorized official
• Roberto Antonacci, M.D.

  • Radiation Oncology Physician
  • Lake Grove, NY
  • NPI 1457302788
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556755200000",
    "number": "1013027283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2780 MIDDLE COUNTRY RD",
            "address_2": "SUITE 210",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117552124",
            "telephone_number": "631-588-4500",
            "fax_number": "631-588-4595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2780 MIDDLE COUNTRY RD",
            "address_2": "SUITE 210",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117552124",
            "telephone_number": "631-588-4500",
            "fax_number": "631-588-4595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUFFOLK BREAST IMAGING PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2019-05-02",
        "status": "A",
        "authorized_official_last_name": "PERKINS",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "631-588-4500",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "51017552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Renee Grindell Mental Health Counselor, P.C.
• Emily Harlan Stetler, MD
• Laura Marie Stonborg
• Marlo Suazo
• Sathish Jay Subbaiah, M.D.
• Suffolk Medical Imaging, PC
• Michelle Nicole Tallini, CF-SLP
• Kari Ann Tanury, LPN
• Nicholas Stephen Teodoro, MD
• Teragram II, Inc

• Diagnostic Radiology Physician in Lake Grove, NY
• Providers in Lake Grove, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.