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NASSAU SUFFOLK MEDICAL PRACTICE, P.C.
NPI 1417998352
Family Medicine in West Babylon, NY

Active since June 10, 2006CLIA 33D2170732 · Waiver
120 ROUTE 109, WEST BABYLON, NY 11704(631) 422-3636(631) 422-2788 Get Directions Write a Review

NPPES record last updated: August 26, 2009. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Nassau Suffolk Medical Practice, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NASSAU SUFFOLK MEDICAL PRACTICE, P.C. (NPI 1417998352) is a healthcare organization registered as a family medicine in West Babylon, New York and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Ani A Bodoutchian, Owner, as its authorized official.

NPPES Registry Identity

NPI1417998352
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameNASSAU SUFFOLK MEDICAL PRACTICE, P.C.
Location Address120 ROUTE 109West Babylon, NY 11704-6210
Mailing Address120 Route 109West Babylon, NY 11704-6210 · (631) 422-3636 · Fax (631) 422-2788
Phone(631) 422-3636
Fax(631) 422-2788
Organization SubpartNo
Authorized OfficialAni A BodoutchianOwner · (631) 422-3636
Enumeration DateJune 10, 2006
Last NPPES UpdateAugust 26, 2009
✔ NPI 1417998352 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
120 ROUTE 109, West Babylon, NY 11704
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Other Identifiers 2

Medicare NSC5443340001NY
Medicare PINW7Z461NY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2170732

Nassau Suffolk Medical Practice A Location Of Stony Brook Internists · West Babylon, NY
Active · expires Mar 26, 2027
CLIA Number33D2170732
Laboratory TypePhysician Office
Certificate Effective DateAugust 19, 2019
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Ani A. Bodoutchian
Laboratory Phone(631) 422-3636
Laboratory LocationNassau Suffolk Medical Practice A Location Of Stony Brook Internists120 Rte 109, West Babylon, NY 11704
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ANI A BODOUTCHIAN M.D.
Family Medicine
120 ROUTE 109
WEST BABYLON, NY 11704
Suffolk County (631) 422-3636

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nassau Suffolk Medical Practice, P.C.'s NPI number?

The NPI number for Nassau Suffolk Medical Practice, P.C. is 1417998352. It was assigned to this organization in the NPPES registry on June 10, 2006.

Where is Nassau Suffolk Medical Practice, P.C. located?

Nassau Suffolk Medical Practice, P.C. is located at 120 Route 109, West Babylon, NY 11704. The listed phone number is (631) 422-3636.

What is Nassau Suffolk Medical Practice, P.C.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Nassau Suffolk Medical Practice, P.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2170732) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Nassau Suffolk Medical Practice, P.C. was last updated on August 26, 2009. NPI Profile syncs with the weekly NPPES data releases published by CMS.