| Idi | |
|
319 Willis Ave Mineola NY 11501-1510 | |
| (516) 487-6453 | |
| Not Available |
| Full Name | Idi |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 319 Willis Ave, Mineola, New York |
| Authorized Official Name and Position | Panagiotis Glavas (CEO) |
| Authorized Official Contact | 5164876453 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idi 319 Willis Ave Mineola NY 11501-1510 Ph: (516) 487-6453 | Idi 319 Willis Ave Mineola NY 11501-1510 Ph: (516) 487-6453 |
| NPI Number | 1144639857 |
|---|---|
| Provider Enumeration Date | 08/06/2014 |
| Last Update Date | 08/13/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144639857 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 047563 (New York) | Primary |
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