Organization
1717 MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORDAN SUDBERG MD (OWNER)
(631) 482-2754
Entity
Organization
Contact information
Practice address
1717 VETERANS MEMORIAL HWY STE 1, ISLANDIA, NY 11749-1532
(631) 203-4300
Mailing address
1717 VETERANS MEMORIAL HWY STE 1, ISLANDIA, NY 11749-1532
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Enumeration date
08/07/2023
Last updated
08/07/2023
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