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General NPI Number Information
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NPI Number | 1477156172
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Entity Type | Organization
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Legal Business Name | VILLAGE INTEGRATIVE FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 7 TEAPOT LN
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City | SMITHTOWN
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State | NY
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Zip | 11787-1800
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Country | US
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Telephone | 631-338-1235
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Fax |
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Provider Business Mailing Address
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Address Line | 7 TEAPOT LN
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City | SMITHTOWN
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State | NY
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Zip | 11787-1800
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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 | OWNER
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Name | ELIZABETH ACEVEDO-DANZI
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Credential |
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Telephone | 631-338-1235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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