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General NPI Number Information
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NPI Number | 1710356043
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Entity Type | Organization
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Legal Business Name | MID NASSAU MEDICAL CARE FOR KIDZ, LLC
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 530 OLD COUNTRY RD SUITE 1B
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City | WESTBURY
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State | NY
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Zip | 11590-4500
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Country | US
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Telephone | 516-333-7272
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Fax | 516-333-2519
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Provider Business Mailing Address
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Address Line | 530 OLD COUNTRY RD SUITE 1B
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City | WESTBURY
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State | NY
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Zip | 11590-4500
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Country | US
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Telephone | 516-333-7272
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Fax | 516-333-2519
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Authorized Official
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Title or Position | M.D./PARTNER
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Name | STEVEN PERRICK
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Credential | M.D.
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Telephone | 516-333-7272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | NY
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