Provider Demographics
NPI:1083009476
Name:MEDICAL HOUSE CALLS OF THE NORTH FORK, PLLC
Entity Type:Organization
Organization Name:MEDICAL HOUSE CALLS OF THE NORTH FORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DESIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-806-7341
Mailing Address - Street 1:53 OSPREY NEST RD
Mailing Address - Street 2:
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-2521
Mailing Address - Country:US
Mailing Address - Phone:631-806-7341
Mailing Address - Fax:631-477-6219
Practice Address - Street 1:53 OSPREY NEST RD
Practice Address - Street 2:
Practice Address - City:GREENPORT
Practice Address - State:NY
Practice Address - Zip Code:11944-2521
Practice Address - Country:US
Practice Address - Phone:631-806-7341
Practice Address - Fax:631-477-6219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216602261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care