Organization · NPI-2
11 Medical Drive Wellness PLLC
Emergency Medicine, Emergency Medical Services · Port Jefferson Station, NY
NPI number1902332588
StatusActive
Last updated in NPPESMay 3, 2017
Details
- NPI
- 1902332588
- Entity type
- Organization (NPI-2)
- Legal business name
- 11 Medical Drive Wellness PLLC
- Organization subpart
- Yes
- Enumeration date
- May 3, 2017
- Last updated
- May 3, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207PE0004X | Emergency Medicine, Emergency Medical Services | – | – | Yes |
Practice location
11 Medical DrSuite B
Port Jefferson Station, NY 11776-1589
Phone 631-509-6066 · Fax 631-849-5824
Mailing address
11 Medical DrSuite B
Port Jefferson Station, NY 11776-1589
Phone 631-509-6066 · Fax 631-849-5824
Authorized official
Laura Roy
Practice Manager
6318056384
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