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General NPI Number Information
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NPI Number | 1962734392
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Entity Type | Organization
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Legal Business Name | ISLAND MEDICAL SERVICES PC
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 2330 UNION BLVD SUITE 1
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City | ISLIP
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State | NY
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Zip | 11751-3172
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Country | US
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Telephone | 631-224-4811
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Fax |
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Provider Business Mailing Address
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Address Line | 2330 UNION BLVD SUITE 1
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City | ISLIP
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State | NY
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Zip | 11751-3172
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Country | US
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Telephone | 631-224-4811
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUNG OH
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Credential | MD
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Telephone | 631-224-4811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 143070
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License Number State | NY
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