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General NPI Number Information
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NPI Number | 1275811820
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Entity Type | Organization
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Legal Business Name | HESHAM M.ATWA PHYSICIAN PC
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 620 BELLE TERRE RD SUITE 5
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2500
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Country | US
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Telephone | 631-476-9296
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Fax | 631-476-9298
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Provider Business Mailing Address
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Address Line | 620 BELLE TERRE RD SUITE 5
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2500
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Country | US
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Telephone | 631-476-9296
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Fax | 631-476-9298
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Authorized Official
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Title or Position | OWNER
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Name | DR. HESHAM M ATWA
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Credential | MD
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Telephone | 66314769296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 221306
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License Number State | NY
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