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Organization
SUPREME MEDICAL P.C.
Active
Organization
SUPREME MEDICAL P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANJANI VENKATA KOTA M.D (PRESIDENT)
(631) 751-8905
Entity
Organization
Contact information
Practice address
100 N BELLE MEAD RD, SUITE D, EAST SETAUKET, NY 11733-3530
(631) 751-8905
(631) 751-8908
Mailing address
100 N BELLE MEAD RD, SUITE D, EAST SETAUKET, NY 11733-3530
(631) 751-8905
(631) 751-8908
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
222728
NY
Other
Enumeration date
12/06/2006
Last updated
03/03/2014
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