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Organization
JOHN T MATHER MEMORIAL HOSPITAL
Active
Organization
JOHN T MATHER MEMORIAL HOSPITAL
Active
Other names
Medical Weight Management
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH WISNOSKI CFO (VP FINANCE)
(631) 473-1320
Entity
Organization
Contact information
Practice address
625 BELLE TERRE RD, SUITE 203, PORT JEFFERSON, NY 11777-2316
(631) 686-7897
(631) 686-2503
Mailing address
625 BELLE TERRE RD, SUITE 203, PORT JEFFERSON, NY 11777-2316
(631) 686-7897
(631) 686-2503
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
—
NULL
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
—
—
363AM0700X
Medical Physician Assistant
—
NULL
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
06/02/2014
Last updated
08/27/2014
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