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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