Organization · NPI-2

25a Medical

Internal Medicine, Pulmonary Disease · Central Islip, NY

NPI number1225748494
StatusActive
Last updated in NPPESNov 29, 2022

Details

NPI
1225748494
Entity type
Organization (NPI-2)
Legal business name
25a Medical
Organization subpart
No
Enumeration date
Nov 29, 2022
Certification date
Nov 23, 2022
Last updated
Nov 29, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207RP1001X Internal Medicine, Pulmonary Disease––Yes
363AM0700X Physician Assistant, Medical––

Practice location

100 W Suffolk Avenue Unit G
Central Islip, NY 11722-2430

Phone 631-993-5400 · Fax 518-712-1634

Mailing address

100 W Suffolk Avenue Unit G
Central Islip, NY 11722-2430

Phone 631-993-5400 · Fax 518-712-1634

Authorized official

Anthony Theodoris
Owner
6319935400

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