Organization
307 LONG ISLAND MEDICAL PC
Active
Organization
307 LONG ISLAND MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANTA MALLIKARJUNA (OFFICE MANAGER)
15164875858
Entity
Organization
Contact information
Practice address
307 E SHORE RD, 2ND FLOOR, GREAT NECK, NY 11023-2420
(516) 487-5858
(516) 487-3133
Mailing address
307 E SHORE RD, 2ND FLOOR, GREAT NECK, NY 11023-2420
(516) 487-5858
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
227976-1
NY
Other
Enumeration date
10/04/2007
Last updated
10/04/2007
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