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General NPI Number Information
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NPI Number | 1386158764
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Entity Type | Organization
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Legal Business Name | ISLAND RHEUMATOLOGY AND OSTEOPOROSIS, PC
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Dates
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Enumeration Date | 11/22/2017
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 6144 ROUTE 25A STE 13
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City | WADING RIVER
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State | NY
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Zip | 11792
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Country | US
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Telephone | 631-886-2488
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 960
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-0813
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Country | US
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Telephone | 917-224-0905
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Fax |
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Authorized Official
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Title or Position | RHEUMATOLOGIST/MEDICAL DIRECTOR
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Name | SANJAY GODHWANI
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Credential | MD
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Telephone | 631-886-2844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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