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521 Route 111 Suite 202 Hauppauge NY 11788-4370 | |
| (631) 361-4625 | |
| (631) 361-2021 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 521 Route 111, Hauppauge, New York |
| Authorized Official Name and Position | Janet Street (ADMINISTRATOR) |
| Authorized Official Contact | 6313513703 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
521 Route 111 Suite 202 Hauppauge NY 11788-4370 Ph: (631) 361-4625 | 521 Route 111 Suite 202 Hauppauge NY 11788-4370 Ph: (631) 361-4625 |
| NPI Number | 1811224868 |
|---|---|
| Provider Enumeration Date | 11/12/2009 |
| Last Update Date | 11/12/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811224868 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 157830 (New York) | Primary |
| 207R00000X | Internal Medicine | 159827 (New York) | Secondary |
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