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Organization
DEPT. OF HEALTH
Active
Organization
DEPT. OF HEALTH
Active
Other names
suffolk county
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH PATRICK MARTONE (REGISTERED NURSE)
(631) 853-7373
Entity
Organization
Contact information
Practice address
200 WIRELESS BLVD, HAUPPAUGE, NY 11788-3933
(631) 853-7373
(631) 853-7380
Mailing address
160 CHERRY LN, MEDFORD, NY 11763-4022
(631) 447-1288
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
376106-1
NY
Other
Enumeration date
03/30/2007
Last updated
08/08/2008
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