Organization · NPI-2
1717 Medical PC
Physical Medicine & Rehabilitation, Sports Medicine · Islandia, NY
NPI number1467134684
StatusActive
Last updated in NPPESAug 7, 2023
Details
- NPI
- 1467134684
- Entity type
- Organization (NPI-2)
- Legal business name
- 1717 Medical PC
- Organization subpart
- No
- Enumeration date
- Aug 7, 2023
- Certification date
- Aug 7, 2023
- Last updated
- Aug 7, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2081S0010X | Physical Medicine & Rehabilitation, Sports Medicine | – | – | Yes |
Practice location
1717 Veterans Memorial Hwy Ste 1Islandia, NY 11749-1532
Phone 631-203-4300
Mailing address
1717 Veterans Memorial Hwy Ste 1Islandia, NY 11749-1532
Authorized official
Jordan Sudberg
Owner
6314822754
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