Custom Trt US INC
NPI #1528883725 in Port Jefferson Station, New York
Provider Information
- NPI Number
- 1528883725
- Entity Type
- Organization
- Organization Name
- Custom Trt US INC
- Primary Specialty
- Clinic/Center - Medical Specialty
- Enumeration Date
- Nov 21, 2024
- Last Updated
- Nov 21, 2024
Practice Location
- Address
- 69 CLYMER STREET
- State
- New York
- ZIP Code
- 11776
- Phone
- (631) 260-1945
Authorized Official
- Name
- AMANDA WIERMANN, PA
- Title
- PRESIDENT
- Phone
- (516) 652-6509
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Medical Specialty — Medical Specialty |
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