| Riverhead Surgery, PC | |
|
4 Technology Drive Suite 220 East Setauket NY 11733-4085 | |
| (631) 476-9296 | |
| (631) 476-9298 |
| Full Name | Riverhead Surgery, PC |
|---|---|
| Speciality | Clinic/Center |
| Location | 4 Technology Drive, East Setauket, New York |
| Authorized Official Name and Position | Hesham Mahmoud Atwa (OWNER) |
| Authorized Official Contact | 6314769296 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverhead Surgery, PC 4 Technology Drive Suite 220 East Setauket NY 11733-4085 Ph: (631) 476-9296 | Riverhead Surgery, PC 4 Technology Drive Suite 220 East Setauket NY 11733-4085 Ph: (631) 476-9296 |
| NPI Number | 1023574589 |
|---|---|
| Provider Enumeration Date | 02/20/2019 |
| Last Update Date | 10/10/2019 |
| Medicare PECOS PAC ID | 5092057836 |
|---|---|
| Medicare Enrollment ID | O20190429000360 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023574589 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| 208600000X | Surgery | () | Secondary |
| Provider Name | Nicholas Craig |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1962445320 PECOS PAC ID: 7315120714 Enrollment ID: I20110322001084 |
| Provider Name | James L Groff |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1598050155 PECOS PAC ID: 3779857214 Enrollment ID: I20190503000438 |
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