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Organization
STATEWIDE TELEHEALTH
Active
Organization
STATEWIDE TELEHEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN DIAZ (OFFICE MANAGR)
(254) 244-1660
Entity
Organization
Contact information
Practice address
89 JUNARD DR, BAY SHORE, NY 11706-4516
(254) 244-1660
Mailing address
89 JUNARD DR, BAY SHORE, NY 11706-4516
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
829824969
—
NY
Enumeration date
02/09/2021
Last updated
02/09/2021
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