Organization · NPI-2

210 Mineola Medical PC

Family Medicine · Mineola, NY

NPI number1821566969
StatusActive
Last updated in NPPESNov 7, 2018

Details

NPI
1821566969
Entity type
Organization (NPI-2)
Legal business name
210 Mineola Medical PC
Organization subpart
No
Enumeration date
Nov 7, 2018
Last updated
Nov 7, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes

Practice location

210 Old Country Rd
Mineola, NY 11501-4218

Phone 516-279-4400

Mailing address

211 Broadway Ste 205
Lynbrook, NY 11563-3290

Authorized official

Irena Musheev
Credentialing Coordinator
5166129837

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