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General NPI Number Information
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NPI Number | 1235226754
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Entity Type | Organization
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Legal Business Name | WESTBURY FAMILY MEDICAL
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 530 OLD COUNTRY RD 2A
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City | WESTBURY
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State | NY
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Zip | 11590-4500
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Country | US
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Telephone | 516-333-9833
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Fax | 516-333-9836
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Provider Business Mailing Address
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Address Line | 530 OLD COUNTRY RD SUITE 2A
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City | WESTBURY
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State | NY
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Zip | 11590-4500
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Country | US
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Telephone | 516-333-9833
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Fax | 516-333-9836
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. EDGAR Z VANEGAS
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Credential | MD
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Telephone | 516-333-9833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 190283-2
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License Number State | NY
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