Organization
NORTHEAST BREAST RECONSTRUCTION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAREEF JANDALI M.D. (OWNER)
(718) 672-2824
Entity
Organization
Contact information
Practice address
21 SOUTHPORT TERRACE, SOUTHPORT, CT 06890
(718) 672-2824
(718) 672-3280
Mailing address
21 SOUTHPORT TERRACE, SOUTHPORT, CT 06890
(718) 672-2824
(718) 672-3280
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
25MA10021400
NJ
Other
Enumeration date
02/06/2017
Last updated
02/06/2017
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