Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Apr 6, 2016
License(s)
299898 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 75 N COUNTRY RD | Port Jefferson, NY 11777-2190 | 631-473-1320 |
| MAILING | 75 N COUNTRY RD | Port Jefferson, NY 11777-2190 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.