MEDICARE: ISLAND WIDE MEDICAL HEALTH SERVICES. 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	207Q00000X	Family Medicine Physician	183817	NY

General Provider Information

NPI Number	:	1720014277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND WIDE MEDICAL HEALTH SERVICES. PC

Provider Business Mailing Address
First Line	:	207 HALLOCK RD
Second Line	:	SUITE 160
City	:	STONY BROOK
State	:	NY
Zip	:	11790-3033
Country	:	US
Telephone Number	:	631-751-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 HALLOCK RD
Second Line	:	SUITE 160
City	:	STONY BROOK
State	:	NY
Zip	:	11790-3033
Country	:	US
Telephone Number	:	631-751-5588
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. MATTHEW J VISO
Credential	:	DC
Telephone Number	:	631-751-5588

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/22/2020

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