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General NPI Number Information
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NPI Number | 1972042075
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Entity Type | Organization
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Legal Business Name | CENTER MORICHES MEDICAL HEALTHCARE PC
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Dates
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Enumeration Date | 02/22/2017
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 2 UNION AVE
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City | CENTER MORICHES
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State | NY
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Zip | 11934-3324
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Country | US
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Telephone | 516-243-8660
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Fax | 516-342-6179
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Provider Business Mailing Address
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Address Line | 131 SUNNYSIDE BLVD STE100
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City | PLAINVIEW
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State | NY
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Zip | 11803-1539
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Country | US
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Telephone | 516-243-8660
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Fax | 516-342-6179
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | BRUCE WEITZBERG
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Credential |
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Telephone | 516-243-8660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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