MEDICARE: MINDFUL MED MANAGEMENT INC

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	261QI0500X	Infusion Therapy Clinic/Center
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1366242273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL MED MANAGEMENT INC

Provider Business Mailing Address
First Line	:	100 MARINERS WAY
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-1848
Country	:	US
Telephone Number	:	631-509-7488
Fax Number	:	631-778-8004

Provider Business Practice Location Address
First Line	:	100 MARINERS WAY
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-1848
Country	:	US
Telephone Number	:	631-991-0052
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	APRIL LEE
Credential	:	NP
Telephone Number	:	631-509-7488

Provider Enumeration Date	:	03/18/2025
Last Update Date	:	04/17/2025

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