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NPI Code Detail

MEDICARE: STATION MEDICAL PC

MEDICARE: STATION MEDICAL PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse Practitioner

General Provider Information

NPI Number : 1821828047
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATION MEDICAL PC
Provider Business Mailing Address
First Line : 1757 NEW YORK AVE
Second Line :
City : HUNTINGTON STATION
State : NY
Zip : 11746-2407
Country : US
Telephone Number : 631-983-3237
Fax Number :
Provider Business Practice Location Address
First Line : 1757 NEW YORK AVE
Second Line :
City : HUNTINGTON STATION
State : NY
Zip : 11746-2407
Country : US
Telephone Number : 631-983-3237
Fax Number :
Authorized Official
Title or Position : PROVIDER (NP)
Name : MUBUSHAR RAZA
Credential : NURSE PRACTITIONER
Telephone Number : 631-983-3237
Provider Enumeration Date : 08/02/2024
Last Update Date : 09/24/2024

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Directions to “STATION MEDICAL PC ” Practice Location

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