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Organization
SHORE TO SHORE MEDICAL WELLNESS PLLC
Active
Organization
SHORE TO SHORE MEDICAL WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY BREVETTI (OWNER)
(917) 575-8907
Entity
Organization
Contact information
Practice address
1500 ROUTE 112 STE B, PORT JEFFERSON STATION, NY 11776-8055
(631) 343-4184
Mailing address
1500 ROUTE 112 STE B, PORT JEFFERSON STATION, NY 11776-8055
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/25/2022
Last updated
02/17/2023
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