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General NPI Number Information
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NPI Number | 1982767752
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Entity Type | Organization
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Legal Business Name | DAC MEDICAL PC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 426 GREAT EAST NECK RD # C
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City | WEST BABYLON
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State | NY
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Zip | 11704-7626
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Country | US
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Telephone | 631-661-6611
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Fax | 631-661-5504
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Provider Business Mailing Address
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Address Line | 426 GREAT EAST NECK RD # C
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City | WEST BABYLON
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State | NY
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Zip | 11704-7626
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Country | US
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Telephone | 631-661-6611
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Fax | 631-661-5504
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. TIMOTHY J MOSOMILLO
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Credential | NMOMM
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Telephone | 631-661-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 185229
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License Number State | NY
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