# FAMILY MEDICAL WELLNESS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174820955
- **Authorized official:** DR. JAMES E CARLSON D.O. (DOCTOR)
- **Authorized official phone:** (631) 928-9326

## Contact information

- **Practice address:** 125 OAKLAND AVE, STE 203, PORT JEFFERSON, NY 11777
- **Practice address phone:** (631) 928-9326
- **Mailing address:** 125 OAKLAND AVE, STE 203 MAIL BOX 6, PORT JEFFERSON, NY 11777
- **Mailing address phone:** (631) 928-9326

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 204062 | NY | Yes |

## Other

- **Enumeration date:** 02/14/2011
- **Last updated:** 02/14/2011