Organization
ISLAND MEDICAL OF MEDFORD, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISSETTE CEPEDA (OFFICE MANAGER)
(631) 758-2220
Entity
Organization
Contact information
Practice address
1647 ROUTE 112, MEDFORD, NY 11763-3635
(631) 758-2220
(631) 758-8355
Mailing address
1647 ROUTE 112, MEDFORD, NY 11763-3635
(631) 758-2220
(631) 758-8355
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
143200
NY
Other
Enumeration date
04/11/2007
Last updated
08/22/2020
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