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General NPI Number Information
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NPI Number | 1932431103
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Entity Type | Organization
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Legal Business Name | EAST NORTHPORT MEDICAL CARE PLLC
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 554 LARKFIELD RD SUITE 101
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-4205
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Country | US
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Telephone | 631-368-9166
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Fax | 631-368-5682
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Provider Business Mailing Address
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Address Line | 554 LARKFIELD RD SUITE 101
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-4205
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Country | US
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Telephone | 631-368-9166
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Fax | 631-368-5682
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ANTHONY J ANTONUCCI
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Credential | MD
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Telephone | 631-368-9166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 226879
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 170689
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License Number State | NY
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