Healthcare Provider Details

I. General information

NPI: 1306141668
Provider Name (Legal Business Name): CONKLIN MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CONKLIN ST
FARMINGDALE NY
11735-2659
US

IV. Provider business mailing address

101 FULTON STREET
FARMINGDALE NY
11735
US

V. Phone/Fax

Practice location:
  • Phone: 516-755-5855
  • Fax:
Mailing address:
  • Phone: 516-755-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN WONG
Title or Position: PRESIDENT
Credential: MD
Phone: 15167555855