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Organization
NASSAU SUFFOLK MEDICAL PRACTICE, P.C.
Active
Organization
NASSAU SUFFOLK MEDICAL PRACTICE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANI A BODOUTCHIAN M.D. (OWNER)
(631) 422-3636
Entity
Organization
Contact information
Practice address
120 ROUTE 109, WEST BABYLON, NY 11704-6210
(631) 422-3636
(631) 422-2788
Mailing address
120 ROUTE 109, WEST BABYLON, NY 11704-6210
(631) 422-3636
(631) 422-2788
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
06/10/2006
Last updated
08/26/2009
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