# THREE VILLAGE MEDICAL, PC

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

## Provider details

- **NPI number:** 1588728125
- **Authorized official:** DR. MATTHEW J VISO DC (MANAGER)
- **Authorized official phone:** (631) 751-5588

## Contact information

- **Practice address:** 207 HALLOCK RD, SUITE 160, STONY BROOK, NY 11790-3033
- **Practice address phone:** (631) 751-5588
- **Practice address fax:** (631) 751-5821
- **Mailing address:** 1890 NEW YORK AVE, HUNTINGTON STATION, NY 11746-2904
- **Mailing address phone:** (631) 427-6920
- **Mailing address fax:** (631) 425-0653

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 103139 | NY | Yes |

## Other

- **Enumeration date:** 12/20/2006
- **Last updated:** 08/22/2020