Organization
ANDREA E NOMBERG PHYSICIAN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA NOMBERG MD (OWNER)
(631) 583-3333
Entity
Organization
Contact information
Practice address
622 HAWKINS AVE, RONKONKOMA, NY 11779-2374
(631) 583-3333
Mailing address
1 VENEZIA CT, DEER PARK, NY 11729-1508
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102723
LICENSE
NY
Enumeration date
06/13/2019
Last updated
02/28/2024
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