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General NPI Number Information
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NPI Number | 1386711497
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Entity Type | Organization
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Legal Business Name | 54 MAIN STREET MEDICAL PRACTICE PC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 129 JACKSON ST
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City | HEMPSTEAD
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State | NY
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Zip | 11550-2412
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Country | US
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Telephone | 516-538-4531
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Fax | 516-292-6287
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Provider Business Mailing Address
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Address Line | 2965 LONG BEACH RD
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City | OCEANSIDE
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State | NY
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Zip | 11572-3255
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Country | US
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Telephone | 516-593-8953
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Fax | 516-292-6287
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD ADDES
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Credential | DO
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Telephone | 516-593-8953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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