Healthcare Provider Details

I. General information

NPI: 1750693701
Provider Name (Legal Business Name): AAT MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 COMMUNITY DR
GREAT NECK NY
11021-5504
US

IV. Provider business mailing address

290 COMMUNITY DR
GREAT NECK NY
11021-5504
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-5044
  • Fax: 516-487-5043
Mailing address:
  • Phone: 516-487-5044
  • Fax: 516-487-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number158334-1
License Number StateNY

VIII. Authorized Official

Name: MICHELLE CSHANC
Title or Position: MANAGER
Credential:
Phone: 516-487-5044