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Organization

JOHN T MATHER MEMORIAL HOSPITAL

Active
Other names
Medical Weight Management
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JOSEPH WISNOSKI CFO (VP FINANCE)
(631) 473-1320
Entity
Organization

Contact information

Practice address
625 BELLE TERRE RD, SUITE 203, PORT JEFFERSON, NY 11777-2316
(631) 686-7897
(631) 686-2503
Mailing address
625 BELLE TERRE RD, SUITE 203, PORT JEFFERSON, NY 11777-2316
(631) 686-7897
(631) 686-2503

Taxonomy

Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
363AM0700X
Medical Physician Assistant

Other

Enumeration date
06/02/2014
Last updated
08/27/2014
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