Organization Name: | PECONIC SURGICAL GROUP, PC |
NPI Number: | 1811187214 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LESLAW JOSEF GREDYSA (PRESIDENT) |
Mailing Address: | 31 Main Rd Suite 2 Riverhead |
State: | NY US |
Postal Code: | 119011953 |
Phone Number: | 6313698539 |
Fax Number: | 6313695613 |
NPI Enumeration Date: | 07/31/2007 |
NPI Last Update Date: | 11/14/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 175169 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |