Healthcare Provider Details

I. General information

NPI: 1013455773
Provider Name (Legal Business Name): WINTHROP COMMUNITY MEDICAL AFFILIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 MAIN RD SUITE F
RIVERHEAD NY
11901-1957
US

IV. Provider business mailing address

700 HICKSVILLE RD SUITE 204
BETHPAGE NY
11714-3471
US

V. Phone/Fax

Practice location:
  • Phone: 631-288-7120
  • Fax:
Mailing address:
  • Phone: 516-576-5842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC ADLER
Title or Position: CO-PRESIDENT
Credential:
Phone: 516-663-3849