Provider Demographics
NPI:1164848818
Name:DOCTORS MEDICAL OFFICE PLLC
Entity Type:Organization
Organization Name:DOCTORS MEDICAL OFFICE PLLC
Other - Org Name:DOCTOR'S MEDICAL OFFICE PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HALTRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-867-5132
Mailing Address - Street 1:1825 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4559
Mailing Address - Country:US
Mailing Address - Phone:516-867-5132
Mailing Address - Fax:516-867-5519
Practice Address - Street 1:1825 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4559
Practice Address - Country:US
Practice Address - Phone:516-867-5132
Practice Address - Fax:516-867-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty