210 Mineola Medical PC

NPI #1821566969 in Mineola, New York

Provider Information

NPI Number: 1821566969
Entity Type: Organization
Organization Name: 210 Mineola Medical PC
Primary Specialty: Family Medicine
Enumeration Date: Nov 7, 2018
Last Updated: Nov 7, 2018

Practice Location

Address: 210 OLD COUNTRY RD
City: Mineola
State: New York
ZIP Code: 11501-4218
Phone: (516) 279-4400

Authorized Official

Name: IRENA MUSHEEV
Title: CREDENTIALING COORDINATOR
Phone: (516) 612-9837

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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