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General NPI Number Information
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NPI Number | 1669328423
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Entity Type | Organization
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Legal Business Name | MEDFORD MEDICAL
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 699A GLEN COVE AVE
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City | GLEN HEAD
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State | NY
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Zip | 11545
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Country | US
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Telephone | 516-858-1828
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Fax |
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Provider Business Mailing Address
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Address Line | 2608 ROUTE 112
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City | MEDFORD
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State | NY
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Zip | 11763-2551
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Country | US
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Telephone | 631-475-4476
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RICKY VOHORA
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Credential | DO
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Telephone | 516-858-1828
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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 |
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License Number State |
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