Organization
DDI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERYL TEITELBAUM (ASSOCIATE DIRECTOR)
(631) 580-4003
Entity
Organization
Contact information
Practice address
90 AIR PARK DR, RONKONKOMA, NY 11779-7360
(631) 580-4031
(631) 471-1954
Mailing address
33 E BELMONT ST, BAY SHORE, NY 11706-1926
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
09/09/2013
Last updated
09/09/2013
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