Organization · NPI-2
Northside Primary Medical Care PC
Internal Medicine · Islandia, NY
NPI number1508066440
StatusActive
Last updated in NPPESOct 2, 2007
Details
- NPI
- 1508066440
- Entity type
- Organization (NPI-2)
- Legal business name
- Northside Primary Medical Care PC
- Organization subpart
- No
- Enumeration date
- Jul 19, 2007
- Last updated
- Oct 2, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | 160056 | NY | Yes |
Practice location
3001 Expressway Dr NSuite 200c
Islandia, NY 11749-5301
Phone 631-435-4358 · Fax 631-435-4583
Mailing address
3001 Expressway Dr NSuite 200c
Islandia, NY 11749-5301
Phone 631-435-4358 · Fax 631-435-4583
Authorized official
Wei K Kao
President
6314354358
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