Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Nov 23, 2020
License(s)
346463 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1500 ROUTE 112 STE 101 | Port Jefferson Station, NY 11776-8054 | 631-751-3000 |
| LOCATION | 365 E MAIN ST | Patchogue, NY 11772-3145 | 631-751-3000 |
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