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General NPI Number Information
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NPI Number | 1467749580
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Entity Type | Organization
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Legal Business Name | WEST ISLIP MEDICAL CARE
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Dates
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Enumeration Date | 07/10/2011
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Last Update Date | 07/10/2011
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Provider Practice Location Address
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Address Line | 510 MONTAUK HWY STE D
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City | WEST ISLIP
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State | NY
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Zip | 11795-4422
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Country | US
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Telephone | 631-587-7474
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2195
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City | NORTH BABYLON
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State | NY
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Zip | 11703-0195
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. ANNA GORSKI-PIASZCZYK
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Credential | M.D.
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Telephone | 631-587-7474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 184078
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License Number State | NY
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