Organization Active NPI

Suffolk Vascular Associates, PLLC

  • Vascular Surgery Physician
  • Port Jefferson Station, NY
National Provider Identifier
1720059926
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
SUFFOLK VASCULAR ASSOCIATES, PLLC
Practice address
1110 Hallock Ave
Port Jefferson Station, NY 11776-1210
Phone
(631) 476-9100
NPI assigned
Jan 27, 2006
Organization subpart
No

Practitioners 25

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

View all 25

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2034522Suffolk Vascular Associates1110 Hallock Avenue, Port Jefferson Station, NY 11776Certificate of waiverDec 27, 2027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041129000540 NY Part B Supplier - Clinic/Group Practice 3375434582 Receives reassigned benefits from 7 practitioners
Practice locations: Smithtown, NY; Riverhead, NY; Nesconset, NY; Port Jefferson Station, NY; Port Jefferson, NY; Amityville, NY; Hauppauge, NY; Patchogue, NY

National Provider Directory

National Provider Directory

Locations

1110 Hallock Ave
Port Jefferson Station, NY 11776
Phone (631) 476-9100

75 N Country Rd
#T
Prt Jefferson, NY 11777
Phone 63147313204428

1149 Old Country Rd
Ste C4
Riverhead, NY 11901
Phone (631) 369-3474

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Robert L. Pollina, M.D.
Title
President
Phone
(631) 476-9100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

1110 Hallock Ave
Port Jefferson Station, NY 11776-1210

Mailing address

1110 Hallock Ave
Port Jefferson Station, NY 11776-1210
Phone (631) 476-9100

NPI Registry JSON

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720059926",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUFFOLK VASCULAR ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POLLINA",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-476-9100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.