Organization
BLUE COAST MEDICAL WELLNESS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY BREVETTI MD (OWNER/PROVIDER)
(917) 575-8907
Entity
Organization
Contact information
Practice address
740 MAIN ROAD, AQUEBOGUE, NY 11931
(631) 343-4184
(631) 343-4168
Mailing address
4875 SUNRISE HWY STE 302, BOHEMIA, NY 11716-4630
(631) 343-4184
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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