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General NPI Number Information
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NPI Number | 1659963718
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Entity Type | Organization
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Legal Business Name | STATEWIDE TELEHEALTH
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 89 JUNARD DR
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City | BAY SHORE
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State | NY
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Zip | 11706-4516
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Country | US
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Telephone | 254-244-1660
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Fax |
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Provider Business Mailing Address
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Address Line | 89 JUNARD DR
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City | BAY SHORE
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State | NY
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Zip | 11706-4516
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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 | OFFICE MANAGR
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Name | CARMEN DIAZ
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Credential |
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Telephone | 254-244-1660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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