Organization
QUALITY MEDICAL MANAGEMENT CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE REENS (AUTHORIZED OFFICIAL)
(631) 446-1190
Entity
Organization
Contact information
Practice address
1110 HALLOCK AVE, PORT JEFFERSON STATION, NY 11776-1210
(631) 476-9100
Mailing address
PO BOX 577, ISLIP, NY 11751-0577
(800) 516-5315
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
03/16/2021
Last updated
03/25/2021
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