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General NPI Number Information
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NPI Number | 1306394978
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Entity Type | Organization
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Legal Business Name | DOUGHTY AND RYZOVA MEDICAL GROUP PC
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 2500 NESCONSET HWY BLDG 14
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 631-689-6226
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Fax | 631-675-0736
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Provider Business Mailing Address
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Address Line | 2500 NESCONSET HWY BLDG 14
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 631-689-6226
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Fax | 631-675-0736
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | KATHLEEN ANN RUSSO
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Credential |
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Telephone | 631-689-6226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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