Healthcare Provider Details

I. General information

NPI: 1891150553
Provider Name (Legal Business Name): WINTHROP COMMUNITY MEDICAL AFFILIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 HICKSVILLE RD
BETHPAGE NY
11714-3415
US

IV. Provider business mailing address

700 HICKSVILLE RD SUITE 204
BETHPAGE NY
11714-3471
US

V. Phone/Fax

Practice location:
  • Phone: 516-576-5822
  • Fax: 516-576-5801
Mailing address:
  • Phone: 516-937-5000
  • Fax: 516-931-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP RAGNO
Title or Position: CO-PRESIDENT
Credential: MD
Phone: 516-877-2629