| Theodore Fried Burford Welch & David Hauer Md, Pc | |
|
388 Hawkins Ave Suite 1 Lake Ronkonkoma NY 11779-4280 | |
| (631) 588-8460 | |
| (631) 588-8480 |
| Full Name | Theodore Fried Burford Welch & David Hauer Md, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 388 Hawkins Ave, Lake Ronkonkoma, New York |
| Authorized Official Name and Position | David Hauer (PRESIDENT) |
| Authorized Official Contact | 6315888460 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theodore Fried Burford Welch & David Hauer Md, Pc 388 Hawkins Ave Suite 1 Lake Ronkonkoma NY 11779-4280 Ph: (631) 588-8460 | Theodore Fried Burford Welch & David Hauer Md, Pc 388 Hawkins Ave Suite 1 Lake Ronkonkoma NY 11779-4280 Ph: (631) 588-8460 |
| NPI Number | 1639233901 |
|---|---|
| Provider Enumeration Date | 12/21/2006 |
| Last Update Date | 12/07/2009 |
| Medicare PECOS PAC ID | 9830088103 |
|---|---|
| Medicare Enrollment ID | O20100218000494 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639233901 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jack Nussbaum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346242690 PECOS PAC ID: 7810031598 Enrollment ID: I20100218000461 |
| Provider Name | Manuel Rosales |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1487656740 PECOS PAC ID: 8224172937 Enrollment ID: I20100218000714 |
| Provider Name | David Hauer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518969880 PECOS PAC ID: 2860536547 Enrollment ID: I20100218000750 |
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Michael Creta, Do Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 290 Hawkins Ave, Lake Ronkonkoma, NY 11779 Phone: 631-981-0045 Fax: 631-981-1117 |