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General NPI Number Information
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NPI Number | 1871888644
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Entity Type | Organization
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Legal Business Name | CAMEO SURGERY
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 06/09/2011
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Provider Practice Location Address
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Address Line | 3750 EXPRESSWAY DR S
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City | ISLANDIA
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State | NY
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Zip | 11749-5575
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Country | US
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Telephone | 631-232-2636
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Fax | 631-232-2637
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Provider Business Mailing Address
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Address Line | 3750 EXPRESSWAY DR S
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City | ISLANDIA
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State | NY
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Zip | 11749-5575
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | SCOTT M BLYER
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Credential | DDS, MD
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Telephone | 631-232-2636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 244114
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License Number State | NY
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