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General NPI Number Information
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NPI Number | 1518082080
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Entity Type | Organization
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Legal Business Name | ISMAIL OZCAN MD PC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 95 CHURCH ST
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779-4159
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Country | US
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Telephone | 631-588-6665
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Fax | 631-580-5543
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Provider Business Mailing Address
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Address Line | 95 CHURCH ST
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779-4159
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Country | US
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Telephone | 631-588-6665
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Fax | 631-580-5543
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Authorized Official
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Title or Position | OWNER
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Name | ISMAIL OZCAN
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Credential | M.D.
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Telephone | 631-588-6665
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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 | 242241
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License Number State | NY
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