Organization
210 MINEOLA MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRENA MUSHEEV (CREDENTIALING COORDINATOR)
(516) 612-9837
Entity
Organization
Contact information
Practice address
210 OLD COUNTRY RD, MINEOLA, NY 11501-4218
(516) 279-4400
Mailing address
211 BROADWAY STE 205, LYNBROOK, NY 11563-3290
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/07/2018
Last updated
11/07/2018
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