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General NPI Number Information
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NPI Number | 1205238672
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Entity Type | Organization
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Legal Business Name | HUNTINGTON MEDICAL GROUP
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Dates
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Enumeration Date | 09/17/2014
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 180 E PULASKI RD
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-1915
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Country | US
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Telephone | 631-425-2140
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Fax |
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Provider Business Mailing Address
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Address Line | 180 E PULASKI RD
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-1915
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Country | US
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Telephone | 631-425-2140
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Fax |
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Authorized Official
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Title or Position | ORTHOPEDIC SURGEON
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Name | DR. JAMES GURTOWSKI
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Credential | M.D
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Telephone | 631-425-2140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | P94766
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License Number State | NY
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