Provider Demographics
NPI:1194284893
Name:MENS HEALTH OF SMITHTOWN
Entity type:Organization
Organization Name:MENS HEALTH OF SMITHTOWN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESADENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:631-343-7880
Mailing Address - Street 1:329 E MIDDLE COUNTRY RD STE 8
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2821
Mailing Address - Country:US
Mailing Address - Phone:631-343-7880
Mailing Address - Fax:631-343-7881
Practice Address - Street 1:329 E MIDDLE COUNTRY RD STE 8
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2821
Practice Address - Country:US
Practice Address - Phone:631-343-7880
Practice Address - Fax:631-343-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy