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General NPI Number Information
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NPI Number | 1881643542
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Entity Type | Organization
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Legal Business Name | GREAT NECK MEDICAL ASSOCIATES, LLP
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 2800 MARCUS AVE SUITE 200
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City | LAKE SUCCESS
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State | NY
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Zip | 11042
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Country | US
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Telephone | 516-608-6820
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Fax | 516-608-6822
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Provider Business Mailing Address
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Address Line | 2 OHIO DR
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City | LAKE SUCCESS
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State | NY
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Zip | 11042-1111
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Country | US
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Telephone | 516-608-6820
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SCOTT KELLMAN
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Credential | MD
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Telephone | 516-608-6820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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