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General NPI Number Information
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NPI Number | 1093207789
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Entity Type | Organization
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Legal Business Name | GEOMARE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 80 WHITE ST
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-4034
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Country | US
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Telephone | 631-255-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 80 WHITE ST
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-4034
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Country | US
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Telephone | 631-255-5500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS M ALIMANESTIANU
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Credential |
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Telephone | 631-255-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 28AV1123730
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License Number State | NY
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