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NPI Code Detail

MEDICARE: COMMUNITY MEDICAL WELLNESS PC

MEDICARE: COMMUNITY MEDICAL WELLNESS 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
1208VP0000XPain Medicine Physician276810-1NY

General Provider Information

NPI Number : 1073002473
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY MEDICAL WELLNESS PC
Provider Business Mailing Address
First Line : PO BOX 463
Second Line :
City : FARMINGVILLE
State : NY
Zip : 11738-0463
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1041 ROUTE 112
Second Line :
City : PORT JEFFERSON STATION
State : NY
Zip : 11776-6000
Country : US
Telephone Number : 516-314-5377
Fax Number :
Authorized Official
Title or Position : OPERATIONS MANAGER
Name : MR. CHRISTOPHER DEFILIPPIS
Credential :
Telephone Number : 516-314-5377
Provider Enumeration Date : 05/02/2018
Last Update Date : 05/02/2018

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Directions to “COMMUNITY MEDICAL WELLNESS PC ” Practice Location

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