Organization
CSR OUTPATIENT MEDICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES MICELI MD (CEO)
(516) 797-1234
Entity
Organization
Contact information
Practice address
585 BROADWAY, MASSAPEQUA, NY 11758-5023
(516) 797-1234
(516) 797-1932
Mailing address
302 MANOR RD, STATEN ISLAND, NY 10314-2408
(718) 815-1000
(718) 815-8122
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
08/30/2013
Last updated
08/30/2013
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