Organization · NPI-2

Healthsource Medical Services PLLC

Internal Medicine · Islandia, NY

NPI number1891028650
StatusActive
Last updated in NPPESAug 11, 2014

Details

NPI
1891028650
Entity type
Organization (NPI-2)
Legal business name
Healthsource Medical Services PLLC
Organization subpart
No
Enumeration date
Sep 11, 2009
Last updated
Aug 11, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine167755NYYes

Practice location

3001 Express Dr N Ste 200c
Islandia, NY 11749-5301

Phone 631-435-0110

Mailing address

Po Box 206
East Setauket, NY 11733-0206

Phone 631-435-0110

Authorized official

John Folan
MD
6314350110

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