Provider Demographics
NPI:1114187986
Name:MEADOWBROOK MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:MEADOWBROOK MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:516-542-3636
Mailing Address - Street 1:865 MERRICK AVE
Mailing Address - Street 2:SUITE N150
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590
Mailing Address - Country:US
Mailing Address - Phone:516-542-3636
Mailing Address - Fax:516-222-8212
Practice Address - Street 1:865 MERRICK AVE
Practice Address - Street 2:SUITE N150
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-542-3636
Practice Address - Fax:516-222-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-14
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty