Organization
25A MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY THEODORIS (OWNER)
(631) 993-5400
Entity
Organization
Contact information
Practice address
100 W SUFFOLK AVENUE UNIT G, CENTRAL ISLIP, NY 11722-2430
(631) 993-5400
(518) 712-1634
Mailing address
100 W SUFFOLK AVENUE UNIT G, CENTRAL ISLIP, NY 11722-2430
(631) 993-5400
(518) 712-1634
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
11/29/2022
Last updated
11/29/2022
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