11 MEDICAL DRIVE WELLNESS PLLC; NPI #1902332588

Contact Information

11 MEDICAL DRIVE WELLNESS PLLC

11 MEDICAL DR
SUITE B
PORT JEFFERSON STATION, NY 11776-1589

Phone: 631-509-6066
Fax: 631-849-5824
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Emergency Medical Services	207PE0004X	93	Physician/Emergency Medicine

Indicates primary specialty

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NPI Profile & details for 11 MEDICAL DRIVE WELLNESS PLLC

NPI Number	`1902332588`
LBN Legal business name	11 MEDICAL DRIVE WELLNESS PLLC
Authorized official	LAURA ROY - (PRACTICE MANAGER)
Entity	Organization
Organization subpart ¹	Yes
Enumeration date	05/03/2017
Last updated	05/03/2017 - About 9 years ago
Identifiers	n/a

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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11 MEDICAL DRIVE WELLNESS PLLC

Contact Information

Specialty

Emergency Medical Services

NPI Profile & details for 11 MEDICAL DRIVE WELLNESS PLLC

Reviews for 11 MEDICAL DRIVE WELLNESS PLLC