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Organization
PECONIC BAY PRIMARY MEDICAL CARE
Active
Organization
PECONIC BAY PRIMARY MEDICAL CARE
Active
Other names
Same
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL O'DONNELL (CFO)
(631) 298-4479
Entity
Organization
Contact information
Practice address
13400 MAIN RD, MATTITUCK, NY 11952-3209
(631) 298-4008
(631) 298-5969
Mailing address
PO BOX 2377, RIVERHEAD, NY 11901-2108
(631) 298-4479
(631) 591-3047
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01714209
—
NY
Enumeration date
02/27/2006
Last updated
05/20/2024
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