Peconic Surgical Group, PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

175169 Issued in NY

Legal business name

PECONIC SURGICAL GROUP, PC

Practice address

31 Main Rd
Suite 2
Riverhead, NY 11901-1953

Phone

(631) 369-8539

Fax

(631) 369-5613

NPI assigned

Jul 31, 2007

Last updated

Nov 14, 2007By 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. Leslaw Josef Gredysa, M.D.NPI 1184729998

Title

President

Phone

(631) 369-8539

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Leslaw J Gredysa, MD

  • Vascular Surgery Physician
  • Riverhead, NY
  • NPI 1184729998
  Authorized official Same address or phone

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

{
    "created_epoch": "1185840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194998400000",
    "number": "1811187214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 MAIN RD",
            "address_2": "SUITE 2",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119011953",
            "telephone_number": "631-369-8539",
            "fax_number": "631-369-5613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 MAIN RD",
            "address_2": "SUITE 2",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119011953",
            "telephone_number": "631-369-8539",
            "fax_number": "631-369-5613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECONIC SURGICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-31",
        "last_updated": "2007-11-14",
        "status": "A",
        "authorized_official_last_name": "GREDYSA",
        "authorized_official_first_name": "LESLAW",
        "authorized_official_middle_name": "JOSEF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-369-8539",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "175169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Peconic Regional Hematology Oncology, PC
• Barbara Theresa Pelczar, R.N.
• Benjamin Penn
• Melissa Mary Penu
• Christopher Brian Peppe, DNP CRNA
• Julia Peragallo

• Specialist in Riverhead, NY
• Providers in Riverhead, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.