Organization
COAST TO COAST MEDICAL WELLNESS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY RAYMOND BREVETTI MD (CMO)
(917) 575-8907
Entity
Organization
Contact information
Practice address
150 BROADHOLLOW RD STE 222, MELVILLE, NY 11747-4901
(631) 343-4184
Mailing address
1500 ROUTE 112 BLDG 8, PORT JEFFERSON STATION, NY 11776-8054
(631) 343-4184
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
10/26/2022
Last updated
10/26/2022
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