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General NPI Number Information
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NPI Number | 1801251814
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Entity Type | Organization
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Legal Business Name | FRIENDLY MEDICAL GROUP PC
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Dates
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Enumeration Date | 12/17/2015
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 207 HALLOCK ROAD
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City | STONY BROOK
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State | NY
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Zip | 11790
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Country | US
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Telephone | 631-689-6226
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Fax | 631-675-0736
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Provider Business Mailing Address
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Address Line | 207 HALLOCK ROAD
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City | STONY BROOK
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State | NY
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Zip | 11790
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Country | US
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Telephone | 631-689-6226
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Fax | 631-675-0736
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. ROSANNA TEDESCO
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Credential |
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Telephone | 631-689-6226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 462504
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 154768
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 60275504
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 248234
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License Number State | NY
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