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General NPI Number Information
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NPI Number | 1881099042
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Entity Type | Organization
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Legal Business Name | ISLAND MEDICAL OFFICE PC
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 4160 MERRICK RD STE 2
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City | MASSAPEQUA
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State | NY
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Zip | 11758-6027
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Country | US
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Telephone | 516-590-7410
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Fax |
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Provider Business Mailing Address
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Address Line | 4160 MERRICK RD STE 2
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City | MASSAPEQUA
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State | NY
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Zip | 11758-6027
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Country | US
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Telephone | 516-590-7410
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT N PRICHEP
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Credential | MD
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Telephone | 516-590-7410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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