SOUTHWEST SUFFOLK MEDICAL, P.C. (NPI# 1104096049) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104096049 |
| Entity Type | Organization |
| Organization Name | SOUTHWEST SUFFOLK MEDICAL, P.C. |
| Practice Address |
48 Route 25a Smithtown NY 11787-1431 |
| Practice Telephone | 6318623000 |
| Practice Fax Number | 6312248560 |
| Mailing Telephone | 6318623000 |
| Mailing Fax Number | 6312248560 |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2008-04-28 |
| Authorized Official Name | MR. DAVE M HANNIGAN JR. (MANAGER OF PHYSICIANS BILL) |
| Authorized Official Telephone | 6312248533 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 2086X0206X |
Surgery Specialization: Surgical Oncology |
Allopathic & Osteopathic Physicians |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | SOUTHWEST SUFFOLK MEDICAL, P.C. | 580 Union Blvd., West Islip, Ny 11795 |
| Street Address |
48 ROUTE 25A |
| City | SMITHTOWN |
| State | NY |
| Zip Code | 11787-1431 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568460343 | Rakesh B Patel | Specialist | 48 Route 25a, Suite 103, Smithtown, NY 11787-1431 | 2005-07-14 |
| 1114345055 | Rakesh B. Patel Physician PC | Specialist | 48 Route 25a, Suite 103, Smithtown, NY 11787-1431 | 2014-03-28 |
| 1730428467 | Southwest Suffolk, P.c | Family Medicine | 48 Route 25a, Suite 210, Smithtown, NY 11787-1431 | 2013-01-31 |
| 1245586528 | North Shore Medical Group of The Mount Sinai School of Medicine | Internal Medicine | 48 Route 25a, Suite 303, Smithtown, NY 11787-1431 | 2012-07-24 |
| 1669748943 | Jessica Piccoli | Physician Assistant | 48 Route 25a, Medical Office Building, Suite 305, Smithtown, NY 11787-1431 | 2012-03-30 |
| 1083986418 | Joseph R Vitolo Md PC | Surgery | 48 Route 25a, Suite 308, Smithtown, NY 11787 | 2012-02-01 |
| 1205168739 | Nick H Gabriel Do PC | Surgery | 48 Route 25a, Suite 104, Smithtown, NY 11787-1431 | 2010-02-09 |
| 1851533699 | Richard Charles Feldstein | Internal Medicine | 48 Route 25a, Suite 107, Smithtown, NY 11787-1431 | 2009-03-25 |
| 1326206079 | Valentina Emilia Radianu | Anesthesiology | 48 Route 25a, Smithtown, NY 11787-1431 | 2008-05-29 |
| 1295992535 | Michael Raymond Weber | Internal Medicine | 48 Route 25a, Suite 103, Smithtown, NY 11787-1431 | 2008-05-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558962779 | Gwendolyn Burris | Counselor | 20 Gilbert Avenue, Suite 107-a, Smithtown, NY 11787 | 2020-11-04 |
| 1467051193 | Karin M Caro | Adult Companion | 9 Three Pond Road, Smithtown, NY 11787 | 2020-10-23 |
| 1639706641 | Nimit Khara | Student in an Organized Health Care Education/Training Program | 240 Middle Country Rd A, Smithtown, NY 11787 | 2020-03-27 |
| 1003469032 | Maria Teresa Gardella | Nurse Practitioner | St. Catherine of Siena Medical Center, 50 Ny-25a, Smithtown, NY 11787 | 2019-07-18 |
| 1558922070 | Pamella Ann Grillo | Physician Assistant | 373 Ny-111 #5, Smithtown, NY 11787 | 2019-06-25 |
| 1306308127 | Sherry Hansen | Social Worker | 285 Middle Country Rd, Suite Ll5, Smithtown, NY 11787 | 2019-04-01 |
| 1932663747 | Kayla Roundsman | Counselor | 11 Route 11, Smithtown, NY 11787 | 2019-01-25 |
| 1568959856 | Moreen Johnson | Registered Nurse | Christian Nursing Registry, 17 Bank Ave, Smith Town, NY 11787 | 2018-04-23 |
| 1992217871 | Erica Zeller Licensed Clinical Social Work Pllc | Social Worker | 15 Bellemeade Ave Ste 3, Smithtown, NY 11787 | 2017-10-31 |
| 1881117802 | Oisin Vincent Keenan | Case Manager/Care Coordinator | 11 Ny-111, Smithtown, NY 11787 | 2017-07-21 |
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| Taxonomy Code | 2086X0206X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Surgical Oncology |
| A surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevention, diagnosis, treatment, and rehabilitation of cancer patients, and devotes a major portion of his or her professional practice to these activities and cancer research. |
| Notes: Source: Society of Surgical Oncology, 2007 [1/1/2008: definition added, source added, 7/1/2009: definiition reformatted] Additional Resources: http://www.surgonc.org/ ; American Board of Medical Specialties, 2007, www.abms.org ; American Board of Surgery, 2007, http://www.absurgery.org/ Surgical oncology is a recognized fellowship subspecialty program of surgery. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033343702 | Jana Lori Deitch | Surgery | 48 Route 25a Ste 301, Smithtown, NY 11787-1454 | 2009-05-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992334379 | Health Quest Medical Practice, PC | Surgery | 670 Stoneleigh Ave Fl 3, Carmel, NY 10512-3997 | 2020-04-07 |
| 1215565783 | Health Quest Medical Practice, PC | Surgery | 1240 Ulster Avenue--breast Depart., Kingston, NY 12401 | 2020-03-31 |
| 1306474879 | Health Quest Medical Practice, PC | Surgery | 1240 Ulster Avenue --surg. Onc. Dept, Kingston, NY 12401 | 2020-03-31 |
| 1336620004 | Jianhong Winson Tan | Surgery | 1233 York Ave Apt 20n, New York, NY 10065-6342 | 2018-08-22 |
| 1306348610 | Health Quest Medical Practice, PC | Surgery | 670 Stoneleigh Ave Ste C126, Carmel, NY 10512-3997 | 2018-03-02 |
| 1316286404 | Harold O Douglass Jr. | Surgery | 72 Andover Ln, Williamsville, NY 14221-3309 | 2013-02-08 |
| 1811246382 | Iain James Nixon | Surgery | 1378 York Ave, Apt 1c, New York, NY 10021-3415 | 2012-08-30 |
| 1578819595 | Dong Kyu Kim | Surgery | 118 Foxwood Dr, Jericho, NY 11753-1116 | 2012-07-27 |
| 1881965903 | William Mahoney | Surgery | 15 Eileen's Path, Box 2738, East Hampton, NY 11937 | 2012-01-20 |
| 1649551953 | Manuela J Junqueira | Surgery | 303 E 60th St Apt 24f, New York, NY 10022-1523 | 2011-08-31 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.