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General NPI Number Information
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NPI Number | 1275373516
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Entity Type | Organization
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Legal Business Name | SEA MEDICAL WELLNESS PC
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 62 JOLINE RD
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-3306
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Country | US
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Telephone | 631-656-6231
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Fax |
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Provider Business Mailing Address
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Address Line | 62 JOLINE RD
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-3306
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Country | US
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Telephone | 631-656-6231
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FARHAD GAZI
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Credential | MD
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Telephone | 917-328-9637
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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