Individual
DR. EDWARD J MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
79 MIDDLEVILLE ROAD, CHIEF OF STAFF OFFICE(11), NORTHPORT, NY 11768
(631) 261-4400
Mailing address
79 MIDDLEVILLE ROAD, NORTHPORT VAMC, CHIEF OF STAFF OFFICE(11), NORTHPORT, NY 11768
(631) 261-4400
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
131445
NY
Other
Enumeration date
07/19/2006
Last updated
07/08/2007
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