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General NPI Number Information
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NPI Number | 1114639309
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Entity Type | Organization
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Legal Business Name | ETTINGER MEDICAL SERVICES PLLC
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 25 BRYCEWOOD DR
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City | DIX HILLS
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State | NY
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Zip | 11746-4906
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Country | US
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Telephone | 631-974-7236
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20550
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-0864
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Country | US
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Telephone | 631-974-7236
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALAN ETTINGER
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Credential | MD
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Telephone | 631-974-7236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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