# 210 MINEOLA MEDICAL PC

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

## Provider details

- **NPI number:** 1821566969
- **Authorized official:** IRENA MUSHEEV (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (516) 612-9837

## Contact information

- **Practice address:** 210 OLD COUNTRY RD, MINEOLA, NY 11501-4218
- **Practice address phone:** (516) 279-4400
- **Mailing address:** 211 BROADWAY STE 205, LYNBROOK, NY 11563-3290

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/07/2018
- **Last updated:** 11/07/2018