MEDICARE: SEAFORD FAMILY PRACTICE-INTERNAL MEDICINE 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
1	261QP2300X	Primary Care Clinic/Center	07653	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07653	OTHER	NY	STATE LICENSE

General Provider Information

NPI Number	:	1184768517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEAFORD FAMILY PRACTICE-INTERNAL MEDICINE PC

Provider Business Mailing Address
First Line	:	3921 MERRICK RD
Second Line	:
City	:	SEAFORD
State	:	NY
Zip	:	11783-2823
Country	:	US
Telephone Number	:	516-785-0660
Fax Number	:	516-785-1099

Provider Business Practice Location Address
First Line	:	3921 MERRICK RD
Second Line	:
City	:	SEAFORD
State	:	NY
Zip	:	11783-2823
Country	:	US
Telephone Number	:	516-785-0660
Fax Number	:	516-785-1099

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	MRS. MYRNA R ELFENBEIN
Credential	:
Telephone Number	:	516-785-0660

Provider Enumeration Date	:	02/18/2007
Last Update Date	:	11/04/2013

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