Provider Demographics
NPI:1730408923
Name:PHYSICIANS PRIVATE PRACTICE, PLLC
Entity type:Organization
Organization Name:PHYSICIANS PRIVATE PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TSARKALIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-265-2222
Mailing Address - Street 1:222 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2871
Mailing Address - Country:US
Mailing Address - Phone:631-265-2222
Mailing Address - Fax:631-265-2227
Practice Address - Street 1:222 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2871
Practice Address - Country:US
Practice Address - Phone:631-265-2222
Practice Address - Fax:631-265-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250691207R00000X
NY251788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty