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General NPI Number Information
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NPI Number | 1245483429
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Entity Type | Organization
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Legal Business Name | HAVEN MEDICAL P.C.
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Dates
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Enumeration Date | 10/31/2008
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 9311 91ST AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2745
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Country | US
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Telephone | 516-385-1525
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Fax | 516-385-1519
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Provider Business Mailing Address
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Address Line | 9311 91ST AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2745
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Country | US
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Telephone | 516-385-1525
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Fax | 516-385-1519
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MORTON AIZIC
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Credential | D.O.
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Telephone | 516-385-1525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 085638-1
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License Number State | NY
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