Healthcare Provider Details

I. General information

NPI: 1326117110
Provider Name (Legal Business Name): EAST MEADOW FAMILY PRACTICE ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 JERUSALEM AVE
WANTAGH NY
11793-2017
US

IV. Provider business mailing address

2840 JERUSALEM AVE
WANTAGH NY
11793-2017
US

V. Phone/Fax

Practice location:
  • Phone: 516-781-1141
  • Fax: 516-781-1184
Mailing address:
  • Phone: 516-781-1141
  • Fax: 516-781-1184

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: BRIAN T MOYNIHAN
Title or Position: PRESIDENT
Credential: DO
Phone: 516-781-1141