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NPI Code Detail

MEDICARE: MIDDLE COUNTRY FAMILY MEDICINE P C

MEDICARE: MIDDLE COUNTRY FAMILY MEDICINE P C
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
1207Q00000XFamily Medicine Physician200458NY

General Provider Information

NPI Number : 1659542827
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDDLE COUNTRY FAMILY MEDICINE P C
Provider Business Mailing Address
First Line : 2539 MIDDLE COUNTRY RD
Second Line : SUITE 5
City : CENTEREACH
State : NY
Zip : 11720-3551
Country : US
Telephone Number : 631-580-1740
Fax Number : 631-580-1955
Provider Business Practice Location Address
First Line : 2539 MIDDLE COUNTRY RD
Second Line : SUITE 5
City : CENTEREACH
State : NY
Zip : 11720-3551
Country : US
Telephone Number : 631-580-1740
Fax Number : 631-580-1955
Authorized Official
Title or Position : PRESIDENT
Name : DR. MICHAEL L. RANDALL
Credential : D.O.
Telephone Number : 631-580-1740
Provider Enumeration Date : 03/17/2008
Last Update Date : 03/24/2014

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Directions to “MIDDLE COUNTRY FAMILY MEDICINE P C ” Practice Location

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