Organization
IME MED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EHSAN BUTT (ADMINISTRATOR)
(631) 838-5320
Entity
Organization
Contact information
Practice address
227 MOUNT PLEASANT RD, HAUPPAUGE, NY 11788-2709
(631) 223-9479
Mailing address
227 MOUNT PLEASANT RD, HAUPPAUGE, NY 11788-2709
(631) 223-9479
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
09/29/2020
Last updated
09/29/2020
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