Organization
MID ISLAND INTERNAL MEDICINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER E LIOTTA (OFFICE MANAGER)
(631) 588-0880
Entity
Organization
Contact information
Practice address
709 HAWKINS AVE, RONKONKOMA, NY 11779-4243
(631) 588-0880
(631) 588-0391
Mailing address
709 HAWKINS AVE, RONKONKOMA, NY 11779-2293
(631) 588-0880
(631) 588-0391
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
199922
NY
Other
Enumeration date
09/19/2007
Last updated
05/27/2009
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