# 11 MEDICAL DRIVE WELLNESS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DH MANAGEMENT GROUP LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1902332588
- **Legal business name:** DH MANAGEMENT GROUP LLC
- **Authorized official:** LAURA ROY (PRACTICE MANAGER)
- **Authorized official phone:** (631) 805-6384

## Contact information

- **Practice address:** 11 MEDICAL DR, SUITE B, PORT JEFFERSON STATION, NY 11776-1589
- **Practice address phone:** (631) 509-6066
- **Practice address fax:** (631) 849-5824
- **Mailing address:** 11 MEDICAL DR, SUITE B, PORT JEFFERSON STATION, NY 11776-1589
- **Mailing address phone:** (631) 509-6066
- **Mailing address fax:** (631) 849-5824

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | NULL | Yes |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/03/2017
- **Last updated:** 05/03/2017