Organization
JOHN T. MATHER MEMORIAL HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH WISNOSKI (CFO)
(631) 473-1320
Entity
Organization
Contact information
Practice address
5505 NESCONSET HWY, MOUNT SINAI, NY 11766-2037
(631) 686-7689
Mailing address
625 BELLE TERRE RD, SUITE 100, PORT JEFFERSON, NY 11777-2316
(631) 686-7689
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03246297
—
NY
Enumeration date
07/08/2010
Last updated
12/15/2010
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