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General NPI Number Information
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NPI Number | 1346774122
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Entity Type | Organization
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Legal Business Name | SETAUKET MEDICAL, PC
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 4 TECHNOLOGY DR SUITE 220
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City | EAST SETAUKET
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State | NY
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Zip | 11733-4080
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Country | US
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Telephone | 631-964-9581
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Fax | 631-476-9298
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Provider Business Mailing Address
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Address Line | 4 TECHNOLOGY DR SUITE 220
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City | EAST SETAUKET
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State | NY
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Zip | 11733-4080
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Country | US
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Telephone | 631-964-9581
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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 | M.D.
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Telephone | 631-476-9296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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