Basic Information
| Provider Information | |||||||||
| NPI: | 1720432677 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WINTHROP COMMUNITY MEDICAL AFFILIATES | ||||||||
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| OtherOrganizationName: | VALLEY STREAM FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 HICKSVILLE RD | ||||||||
| Address2: | 204 | ||||||||
| City: | BETHPAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117143471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165765822 | ||||||||
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| Practice Location | |||||||||
| Address1: | 70 E SUNRISE HWY | ||||||||
| Address2: | 610 | ||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115811240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165365656 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2016 | ||||||||
| LastUpdateDate: | 05/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | ADLER | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5166633849 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.