Provider Demographics
NPI:1114639309
Name:ETTINGER MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:ETTINGER MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-974-7236
Mailing Address - Street 1:PO BOX 20550
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-0864
Mailing Address - Country:US
Mailing Address - Phone:631-974-7236
Mailing Address - Fax:
Practice Address - Street 1:25 BRYCEWOOD DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-4906
Practice Address - Country:US
Practice Address - Phone:631-974-7236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty