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General NPI Number Information
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NPI Number | 1841617412
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Entity Type | Organization
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Legal Business Name | PLATINUM FAMILY MEDICINE P.C.
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Dates
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Enumeration Date | 03/21/2014
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 765 ROUTE 25A
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City | MILLER PLACE
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State | NY
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Zip | 11764-2649
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Country | US
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Telephone | 631-849-5900
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Fax | 631-849-5897
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Provider Business Mailing Address
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Address Line | 765 ROUTE 25A
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City | MILLER PLACE
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State | NY
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Zip | 11764-2649
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Country | US
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Telephone | 631-849-5900
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Fax | 631-849-5897
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH VENEZIA
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Credential | M.D.
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Telephone | 631-675-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 1995901
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1995901
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License Number State | NY
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