| Andrea E Nomberg Physician Pc | |
|
622 Hawkins Ave Ronkonkoma NY 11779-2374 | |
| (631) 583-3333 | |
| Not Available |
| Full Name | Andrea E Nomberg Physician Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 622 Hawkins Ave, Ronkonkoma, New York |
| Authorized Official Name and Position | Andrea Nomberg (OWNER) |
| Authorized Official Contact | 6315833333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Andrea E Nomberg Physician Pc 1 Venezia Ct Deer Park NY 11729-1508 Ph: () - | Andrea E Nomberg Physician Pc 622 Hawkins Ave Ronkonkoma NY 11779-2374 Ph: (631) 583-3333 |
| NPI Number | 1295394120 |
|---|---|
| Provider Enumeration Date | 06/13/2019 |
| Last Update Date | 02/28/2024 |
| Medicare PECOS PAC ID | 5698000123 |
|---|---|
| Medicare Enrollment ID | O20190705000455 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295394120 | NPI | - | NPPES |
| 102723 | Other | NY | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Andrea Nomberg |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1336223445 PECOS PAC ID: 4385543511 Enrollment ID: I20040107000086 |
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