Provider Demographics
NPI:1992243018
Name:FIVE TOWNS MEDICINE, PC
Entity type:Organization
Organization Name:FIVE TOWNS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:OSTREICHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-374-6363
Mailing Address - Street 1:123 MAPLE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2240
Mailing Address - Country:US
Mailing Address - Phone:516-374-6363
Mailing Address - Fax:
Practice Address - Street 1:123 MAPLE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2240
Practice Address - Country:US
Practice Address - Phone:516-374-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256063174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty