Organization
SOUTH NASSAU PHYSICIAN PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAJIV V DATTA MD (DIRECTOR)
(516) 632-3350
Entity
Organization
Contact information
Practice address
1 S CENTRAL AVE, VALLEY STREAM, NY 11580-5443
(516) 632-3350
(516) 632-3355
Mailing address
1 S CENTRAL AVE, VALLEY STREAM, NY 11580-5443
(516) 632-3350
(516) 632-3355
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
200879
NY
208600000X
Surgery Physician
Primary
201327
NY
208600000X
Surgery Physician
242239
NY
Other
Enumeration date
09/30/2008
Last updated
09/30/2008
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