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General NPI Number Information
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NPI Number | 1588081889
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Entity Type | Organization
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Legal Business Name | MEDICAL DOCTOR VISIT ME PLLC
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 570 SMITH HAVEN MALL
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City | LAKE GROVE
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State | NY
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Zip | 11755-1206
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Country | US
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Telephone | 631-338-8131
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Fax |
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Provider Business Mailing Address
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Address Line | 570 SMITH HAVEN MALL
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City | LAKE GROVE
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State | NY
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Zip | 11755-1206
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Country | US
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Telephone | 631-338-8131
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. PRADEEP ALBERT
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Credential | MD
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Telephone | 631-338-8131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 222985
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License Number State | NY
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