Organization
ACTIVE MEDICAL DIAGNOSTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY J MOSOMILLO DO, NMM (MEDICAL DIRECTOR)
(631) 661-6611
Entity
Organization
Contact information
Practice address
422C GREAT EAST NECK ROAD, WEST BABYLON, NY 11704
(631) 661-6611
(631) 661-5504
Mailing address
422C GREAT EAST NECK ROAD, WEST BABYLON, NY 11704
(631) 661-6611
(631) 661-5504
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
09/30/2008
Last updated
09/30/2008
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