| Supreme Medical P.c. | |
|
100 N Belle Mead Rd Suite D East Setauket NY 11733-3530 | |
| (631) 751-8905 | |
| (631) 751-8908 |
| Full Name | Supreme Medical P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 100 N Belle Mead Rd, East Setauket, New York |
| Authorized Official Name and Position | Anjani Venkata Kota (PRESIDENT) |
| Authorized Official Contact | 6317518905 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supreme Medical P.c. 100 N Belle Mead Rd Suite D East Setauket NY 11733-3530 Ph: (631) 751-8905 | Supreme Medical P.c. 100 N Belle Mead Rd Suite D East Setauket NY 11733-3530 Ph: (631) 751-8905 |
| NPI Number | 1902965171 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 03/03/2014 |
| Medicare PECOS PAC ID | 8325111552 |
|---|---|
| Medicare Enrollment ID | O20080722000443 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902965171 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 222728 (New York) | Primary |
| Provider Name | Anjani V Kota |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720055353 PECOS PAC ID: 7214996289 Enrollment ID: I20041005001331 |
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