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General NPI Number Information
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NPI Number | 1306142245
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Entity Type | Organization
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Legal Business Name | 51 JOHN STREET MEDICAL PC
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 51 JOHN ST STE 4
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City | BABYLON
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State | NY
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Zip | 11702-2928
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Country | US
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Telephone | 631-661-0400
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Fax | 631-661-0463
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Provider Business Mailing Address
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Address Line | 51 JOHN ST SUITE 4
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City | BABYLON
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State | NY
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Zip | 11702-2928
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Country | US
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Telephone | 631-669-0500
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Fax | 631-661-0463
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. TERESA A FULLER
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Credential |
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Telephone | 631-661-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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