Self Employed

Specialty details in registry · Mastic Beach, NY

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At a glance

74 Mill Dr, Mastic Beach, NY 11951-1403

NPPES record updated Nov 9, 2015. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

74 Mill Dr
Mastic Beach, NY 11951-1403

Professional details: NPI, taxonomy & registry record

NPI1033582291

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 314000000X
Enumeration date: Nov 9, 2015
Record updated: Nov 9, 2015

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

314000000X · Primary

License reported: 705976-1 NY

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

74 Mill Dr
Mastic Beach, NY 11951-1403

Phone: (631) 599-8372

Mailing address

67 RADBURN DR

FARMINGVILLE, NY 117381046

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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