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General NPI Number Information
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NPI Number | 1255359600
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Entity Type | Organization
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Legal Business Name | EAST END PLASTIC, RECONSTRUCTIVE & HAND SURGERY, P.C.
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1267 E MAIN ST
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City | RIVERHEAD
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State | NY
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Zip | 11901-2673
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Country | US
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Telephone | 631-369-0490
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Fax | 631-369-6421
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Provider Business Mailing Address
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Address Line | 1267 E MAIN ST
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City | RIVERHEAD
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State | NY
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Zip | 11901-2673
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Country | US
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Telephone | 631-369-0490
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Fax | 631-369-6421
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JUDY ANN EMANUELE
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Credential | M.D.
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Telephone | 631-369-0490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | 206403
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License Number State | NY
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