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NPI Code Detail

MEDICARE: BOHEMIA MEDICAL, PC

MEDICARE: BOHEMIA MEDICAL, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician188150NY

General Provider Information

NPI Number : 1063440659
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOHEMIA MEDICAL, PC
Provider Business Mailing Address
First Line : 4155 VETERANS MEMORIAL HWY STE 5
Second Line :
City : RONKONKOMA
State : NY
Zip : 11779-6063
Country : US
Telephone Number : 516-234-0018
Fax Number : 888-487-1086
Provider Business Practice Location Address
First Line : 4155 VETERANS MEMORIAL HWY STE 5
Second Line :
City : RONKONKOMA
State : NY
Zip : 11779-6063
Country : US
Telephone Number : 631-412-4800
Fax Number :
Authorized Official
Title or Position : DO
Name : BARRY WEIN
Credential :
Telephone Number : 631-738-8300
Provider Enumeration Date : 06/30/2006
Last Update Date : 07/24/2024

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