COUNTY OF SUFFOLK

NPI # 

Practice Address:

200 Wireless Blvd

Hauppauge, NY, 11788-3974

Practice Phone:

631-853-7373

License Number:

040710508

License State:

NY

Taxonomy Grouping:

Ambulatory Health Care Facilities

Taxonomy Classification:

Clinic/Center

Taxonomy Specialization:

Methadone

Taxonomy Code:

261QM2800X