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Organization

INTEGRATED TRIBOROUGH MEDICAL, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PERRY STEVENS M.D. (OWNER)
(631) 271-9151
Entity
Organization

Contact information

Practice address
1000 NORTHERN BLVD, SUITE 175, GREAT NECK, NY 11021-5338
(631) 271-9151
(631) 271-9155
Mailing address
1000 NORTHERN BLVD, SUITE 175, GREAT NECK, NY 11021-5338
(631) 271-9151
(631) 271-9155

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
179574
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
179574
LICENSE
NY
Enumeration date
06/06/2013
Last updated
06/06/2013
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