| Modern Family Medicine Pc | |
|
258 W Main St Babylon NY 11702-3443 | |
| (631) 517-9170 | |
| (631) 517-9113 |
| Full Name | Modern Family Medicine Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 258 W Main St, Babylon, New York |
| Authorized Official Name and Position | Marina Andrianova (PHYSICIAN) |
| Authorized Official Contact | 5165129435 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Family Medicine Pc 258 W Main St Babylon NY 11702-3443 Ph: (631) 517-9170 | Modern Family Medicine Pc 258 W Main St Babylon NY 11702-3443 Ph: (631) 517-9170 |
| NPI Number | 1861890493 |
|---|---|
| Provider Enumeration Date | 12/13/2014 |
| Last Update Date | 02/11/2015 |
| Medicare PECOS PAC ID | 3173848397 |
|---|---|
| Medicare Enrollment ID | O20150211000674 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861890493 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 272088 (New York) | Primary |
| Provider Name | Alexandre Andrianov |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467441774 PECOS PAC ID: 5496785289 Enrollment ID: I20131004000530 |
| Provider Name | Marina Andrianova |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508184029 PECOS PAC ID: 2365674074 Enrollment ID: I20141022001763 |
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