Organization · NPI-2

300 Old Country Road Medical PLLC

Obstetrics & Gynecology · Mineola, NY

NPI number1164935276
StatusActive
Last updated in NPPESNov 10, 2017

Details

NPI
1164935276
Entity type
Organization (NPI-2)
Legal business name
300 Old Country Road Medical PLLC
Organization subpart
No
Enumeration date
Nov 10, 2017
Last updated
Nov 10, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207V00000X Obstetrics & Gynecology––Yes

Practice location

300 Old Country Rd Ste 201
Mineola, NY 11501-4199

Phone 516-702-4924

Mailing address

1231 Moores Hill Rd
Syosset, NY 11791-9631

Authorized official

Lawrence Tydings
Medical Director
5167024924

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