Suffolk Medical Specialist, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

159940 Issued in NY

Legal business name

SUFFOLK MEDICAL SPECIALIST, PLLC

Practice address

1110 Hallock Ave
Port Jefferson Station, NY 11776-1210

Phone

(631) 476-9100

Fax

(631) 476-4919

NPI assigned

Feb 9, 2006

Last updated

Dec 12, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Norman R Bennett, M.D.NPI 1700857786

Title

Owner

Phone

(631) 476-9100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

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.

• Norman R Bennett, M.D.

  • Internal Medicine Physician
  • Port Jefferson, NY
  • NPI 1700857786
  Medicare reassignment NPD Authorized official
• Kelly Ann Godberson, NP

  • Nurse Practitioner
  • Medford, NY
  • NPI 1053833962
  Medicare reassignment NPD
• Rosario J Romano, MD

  • Internal Medicine Physician
  • Port Jefferson, NY
  • NPI 1356442107
  NPD (past)

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418342400000",
    "number": "1710950688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 HALLOCK AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761210",
            "telephone_number": "631-476-9100",
            "fax_number": "631-476-4919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 HALLOCK AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761210",
            "telephone_number": "631-476-9100",
            "fax_number": "631-476-4919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUFFOLK MEDICAL SPECIALIST, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-09",
        "last_updated": "2014-12-12",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "NORMAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-476-9100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "159940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassie Nicole Struhs
• Luis Suarez, MHC
• Supriya Subedi
• Suffolk Brain and Nerve, PLLC
• Suffolk Interventional Suites Inc.
• Suffolk Pediatric Dentistry
• Suffolk Vascular Associates, PLLC
• John Paul Sugrue, M.D.
• Kelly Sullivan, RN
• Sup Acupuncture PLLC

• Internal Medicine Physician in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2014; 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.