Organization
MELVILLE SC, LLC
Active
Other names
Melville SC Anesthesia
Organization subpart
No
Provider details
NPI number
Authorized official
PROF. DANIEL FORSBERG PA-C (EXECUTIVE DIRECTOR)
(631) 293-9700
Entity
Organization
Contact information
Practice address
1895 WALT WHITMAN RD, SUITE 10, MELVILLE, NY 11747-3031
(631) 293-9700
(631) 293-2021
Mailing address
1895 WALT WHITMAN RD, SUITE 10, MELVILLE, NY 11747-3031
(631) 293-9700
(631) 293-2021
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
5153209R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01287085
—
NY
01
—
33D0654179
CLIA
NY
Enumeration date
11/15/2013
Last updated
11/15/2013
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