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General NPI Number Information
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NPI Number | 1780855817
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Entity Type | Organization
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Legal Business Name | AMITYVILLE INTERNAL MEDICINE, P.C.
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 49 IRELAND PL
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City | AMITYVILLE
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State | NY
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Zip | 11701-2902
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Country | US
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Telephone | 631-264-0924
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Fax | 631-264-3503
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Provider Business Mailing Address
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Address Line | 49 IRELAND PL
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City | AMITYVILLE
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State | NY
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Zip | 11701-2902
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Country | US
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Telephone | 631-264-0924
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Fax | 631-264-3503
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Authorized Official
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Title or Position | BILLING SECRETARY
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Name | KELLI QUENZER
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Credential |
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Telephone | 631-264-0924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 132857
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License Number State | NY
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