Provider Demographics
NPI:1528777810
Name:NORTH FORK MEDICAL PLLC
Entity type:Organization
Organization Name:NORTH FORK MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:631-886-1500
Mailing Address - Street 1:6278 ROUTE 25A STE 4
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2009
Mailing Address - Country:US
Mailing Address - Phone:631-886-1500
Mailing Address - Fax:631-886-1831
Practice Address - Street 1:6278 ROUTE 25A STE 4
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2009
Practice Address - Country:US
Practice Address - Phone:631-886-1500
Practice Address - Fax:631-886-1831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty