Riverhead Surgery, PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

RIVERHEAD SURGERY, PC

Practice address

4 Technology Drive
Suite 220
East Setauket, NY 11733-4085

Phone

(631) 476-9296

Fax

(631) 476-9298

NPI assigned

Feb 20, 2019

Organization subpart

No

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

Authorized official

Name

Hesham Mahmoud Atwa, M.D.NPI 1841286788

Title

Owner

Phone

(631) 476-9296

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicholas Peter Craig, M.D.

  • Surgery Physician
  • Port Jefferson, NY
  • NPI 1962445320
  Medicare reassignment NPD
• James Leo Groff, D.O.

  • Trauma Surgery Physician
  • Bridgehampton, NY
  • NPI 1598050155

  Single Specialty

  Medicare reassignment NPD
• Hesham Mahmoud Atwa, M.D.

  • Surgery Physician
  • Port Jefferson, NY
  • NPI 1841286788
  NPD (past) Authorized official

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

{
    "created_epoch": "1550620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1023574589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 TECHNOLOGY DRIVE",
            "address_2": "SUITE 220",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117334085",
            "telephone_number": "631-476-9296",
            "fax_number": "631-476-9298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 TECHNOLOGY DRIVE",
            "address_2": "SUITE 220",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117334085",
            "telephone_number": "631-476-9296",
            "fax_number": "631-476-9298"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "715 Roanoke Ave",
            "address_purpose": "LOCATION",
            "city": "Riverhead",
            "state": "NY",
            "postal_code": "119012769",
            "country_code": "US",
            "telephone_number": "631-476-9296",
            "fax_number": "631-476-9298",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RIVERHEAD SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-20",
        "last_updated": "2019-10-10",
        "status": "A",
        "authorized_official_last_name": "ATWA",
        "authorized_official_first_name": "HESHAM",
        "authorized_official_middle_name": "MAHMOUD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-476-9296",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynn Riis
• Lisa M. Rimpel, M.D.
• Haley Anne Riordan, PHYSICIAN ASSISTANT
• Brittany Rivera, MS, CCC-SLP
• Evan Rivera, NP
• Angelo Victor Rizzi, RPA C
• Lisa Rizzuto, PA
• Timothy Michael Roberts, PA-C
• Kathleen Rogers, LCSW CRC
• Christina Alysse Romano, PA-C

• Clinic/Center in East Setauket, NY
• Providers in East Setauket, NY by specialty
• Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.